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Cold Plunge Waiver Form

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

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Please submit before arrival.

Todays Date
Day
Month
Year
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
Heart conditions/ Cardiovascular disease.
High/ low blood pressure not medically managed.
History of stroke/ seizures.
Respiratory conditions - eg uncontrolled asthma.
Reynaud's syndrome.
Cold Urticaria.
Pregnancy.
Recent surgery or injury.
Any condition where cold water exposure is contraindicated.
Please state anything you feel may be relevant here - For example any medication you are currently taking. If you are unsure please seek medical advice.
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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
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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
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.
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At some events food is provided. Please inform us of any dietary requirements & food allergies. If this is a 1:1 booking just click not applicable.
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