Floatation Waiver

Floating is an inherently safe and low risk activity, it was developed in the 1950s and has many hundreds of research
studies performed by doctors and scientists investigating the various benefits and claims. There are very few risks when it
comes to floating, and if you abide by our directions we can ensure that any risks are minimised.

Ayana Wellness Spa will make every reasonable effort to provide and ensure a comfortable, clean and safe floating
environment for you and ask that you comply with all our directives and procedures. Please read and mark each of the
following statements of this agreement and sign at the bottom of the page:

____ I do not have any communicable or infectious disease, illness, open sores, or skin disorders.
____ I am not undergoing chemotherapy or radiation treatment, a 2 month wait is required after the last treatment.
____​ I do not have freshly dyed (coloured) hair​ (i.e. when I shower the water runs clear).
____ I am not under the influence of drugs or alcohol or non-prescribed medication.
____ I do not have a condition where I am receiving medication that may be adversely affected by deep relaxation and/or immersion in an Epsom salt
solution.
____ I do not have untreated high (>+180/120) or low (<-90/50) blood pressure.
____ I am not diabetic with insulin dependency, or I have medical authorisation to float.
____ I do not have chronic heart or kidney disease. If I do, I have medical authorisation to float.
____ I do not suffer from seizures or epilepsy. If I do, I have medical authorisation to float.
____ I do not have claustrophobia. If I do, I have medical authorisation to float.
____ I am at least 18 years of age or have guardian with me to sign waiver.
____ If Pregnant - I have discussed with my health professional and am authorized to float.
____ I will not float with soaps, oils or creams on my body, hair products, jewelry or contact lenses.
____ I feel well today, have no incontinence or nausea, and will only float when I feel well.
____ I will receive an orientation, which familiarizes me with the safe and appropriate use of the Float Room. I understand that individual experiences
with floating are varied and unique, and I take full responsibility for my thoughts and actions while in the flotation pool. This waiver of liability and all
agreements made herein shall apply to each and every use of the tank.
____ I waive, release and discharge from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or
persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me
including my traveling to and from my session.
____ There is the potential for the floors to be wet and as such slippery, due to in room showers and the float chambers themselves containing water. I
waive, release and discharge from any and all liability Ayana Wellness Spa for any slips or falls that may occur on the premises.
____ I have read and fully understand and agree to the terms of this Liability Waiver Agreement. I am signing this agreement voluntarily and recognize
that my signature serves as complete and unconditional release of all liability in connection with the use of the flotation chamber and facilities, including
the entire interior of the premises operated as Ayana Wellness Spa, its agents and all employees, whether such loss or damage be it direct or indirect.
____ I understand that if I do something that causes damage to the Ayana Wellness Spa Float Room, any other part of Ayana Wellness Spa, or its
contents, I am financially responsible.
____ I acknowledge that the above is true and correct, if Ayana Wellness Spa is required to replace the magnesium sulphate solution due to a breach of
the above statements, up to a $1,500 solution replacement fee will be paid by the client. (examples that would require the solution to be replaced could
be a communicable or infectious disease, diarrhea, chemotherapy or radiation treatment and ​hair colouring​).
____ I indemnify, hold harmless, and will not sue Ayana Wellness Spa, its owners, and/or its employees.
____ Ayana Wellness Spa has a cancellation policy, if less than 24 hours notice of cancellation is provided, charges will apply for the cancelled session.
____ Please notify staff if you have any minor cuts and ask for some petroleum jelly to seal them from the salt water.

Name: _________________________________________ Date: ____________________________________

Emergency Contact & Phone #: ______________________________________________________________

Signature: _______________________________________________________________________________

Complete if person who is Floating is under 18:

Parent/Guardian Name: ____________________________________________________________________

Parent/Guardian Signature: _________________________________________________________________