Name *

First Name

Last Name

Liability Waiver *

WAIVER OF LIABILITY AND ASSUMPTION OF RISKS - Please read the following carefully, and check "I agree" when you are ready to proceed. NOTE: YOU MUST READ AND SIGN THIS WAIVER BEFORE PARTICIPATING IN THE SERVICES PROVIDED BY URBAN BANYA INC. (the “Session”) IN CONSIDERATION FOR MY PARTICIPATION IN THE SESSION, I knowingly and freely assume as follows: I UNDERSTAND AND ACCEPT that the Session includes physical movements as well as an opportunity for enhanced mindfulness, better sleep quality and enhancement of immune function through the immersion of the body in hot and cold water. As is the case with any high-intensity activity, the risk of harm, serious or disabling injuries, and even death is always present and cannot be entirely eliminated. Specific risks include, but are not limited to burns, muscle and joint sprains and strains, equipment failure, drowning, hyperventilation, syncope, hypothermia, anaphylactic shock or impairment to other aspects of my body, general health and well-being. If I experience any pain or discomfort, immediately discontinue the activity and ask for support from the employees on-site. I voluntarily accept and assume all the risk associated with the Session and I chose to participate despite the risks. I ACKNOWLEDGE THAT, in addition to the risks described above, my participation entails additional risks due to reduced lighting. I understand that the reduced lighting during the Session can affect depth perception and visibility and may cause me to fall or slip. I ACCEPT full responsibility for any and all damages and injuries which I may incur, directly or indirectly, through my participation in the Session. These Sessions not a substitute for medical attention, examination, diagnosis or treatment. By signing below, I accept the responsibility of discussing my use of the facilities and participation in the Sessions with my physician and to obtain adequate medical, health, accident and other forms of insurance coverage that may apply. In addition, I will make the instructor aware of any medical conditions or physical limitations I may have before the Session begins and seek assistance when necessary. If I am pregnant, become pregnant or I am post-natal or post-surgical or breastfeeding, my signature verifies that I have my physician's approval to participate in the Session. I also acknowledge that my participation in the Session is at my own risk. I ACCEPT full responsibility for any and all damages and injuries which any guest I bring on the premises may incur, directly or indirectly, through their participation in the Session.I HEREBY IRREVOCABLY RELEASE AND WAIVE ANY CLAIMS, DEMAND OR ACTION AGAINST URBAN BANYA INC., its officers, directors, employees, agents and contractors (including instructors and assistants), and other representatives which I now have or hereafter can, shall or may have for or by reason of any cause, expense, loss, matter, or thing whatsoever including, but without limiting the generality of the foregoing, all claims or injuries which may arise from my participation in the Session. I further acknowledge that this Waiver of Liability shall apply to the Session before which it is being signed and to any subsequent Session or other services provided by Urban Banya Inc. to the undersigned. I agree that if any portion of this Agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect. I accept that this document shall be binding upon my heirs, next of kin, executors, assigns and representatives in the event of my death or incapacity. I am signing this agreement voluntarily and recognize that my signature serves as complete and unconditional release of any and all liability arising from the services provided by Urban Banya Inc. to the greatest extent allowed by law in the Province of Ontario, Canada. I ATTEST AND VERIFY THAT, unless indicated above: I am over 18 years of age; I am free from all illnesses, injuries and defects that could interfere with my safe participation in any of the above Sessions; I represent and warrant that I have no psychological, medical or emotional condition which would prevent me from sage participation in the Sessions; I have read all the rules and warning associated with the activities the Company offers;I am free of any alcohol and/or any drug, substance or medication that may affect my perception or ability in any way to safely participate in the Activities; The information in this form is correct and complete; I agree to obey and follow all rules and instructions given by the staff or facilitators for the activities I participate in. If for any reason the activity becomes unsafe in any way, I will remove myself from the activity and notify a staff member immediately; and I am responsible for my personal belongings. The Company or its employees will not be responsible for lost or stolen belonging.