Waiver Form: Cold Plunge and Sauna

Cold Plunge Waiver Form

This form is required before using either the cold plunge or sauna facilities.

Please submit before arrival.

Todays Date

Day

Month

Year

First name

Last name

Address

Phone

Birthday

Day

Month

Year

Name of Emergency Contact

Emergency Contact

Health Advice for Cold Plunge: If you have a medical condition like heart disease, low/ high blood pressure or are pregnant, cold water therapy is NOT recommended. Please seek advice from a doctor.

I have had advice from a doctor

Not Applicable

I understand that I am responsible for my own health and wellbeing when using the cold plunge. I will listen to my body and to my coach.

I confirm and accept responsibility

Liability Waiver: I understand that using the cold plunge involves inherent risks including but not limited to personal injury, death & damage to property. I agree take responsiblity & I do not hold Pippa Newman Reiki responsible for any resulting harm.

I voluntarily assume all risks

Please sign here to confirm liability waiver.

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Beginners should start with shorter durations in the cold plunge of around 1-2 mins. I will exit the cold plunge should I feel any discomfort beyond the usual cold sensation.

I am a beginner and will follow guidance.

I regularly use cold plunge

Medical Waiver: Please disclose any current or past medical issues that may be relevant. Are you currently taking any medication?

Other Contraindications: Cold water therapy can cause hypothermia and cold water shock. I agree to listen to my coach so that I am able to spot the signs & follow guidance.

I agree to follow guidance.

I allow any photos, videos or testimonials to be used by Pippa Newman Reiki on social media & website.

Yes, I agree.

No, please do not use my images or testimonials.

I agree that my answers are correct & I have disclosed all relevant information.

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Cold Plunge Waiver Form

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