Health check - alansalter.co.uk

Please complete this form before your session. It takes around 3 minutes and ensures we can look after you properly. All information is kept securely and used only for session safety purposes.

Your details

Full name *

Email address *

Contact number *

Emergency contact

Emergency contact name *

Emergency contact number *

Cold water experience

How would you describe your cold water experience? *

New to cold water — this is my first time Cold showers only Some experience — Wim Hof or breathwork background Experienced — regular cold plunges or open water swimming

Safety waiver & agreement

Safety Warning

Cold water immersion and contrast therapy carry inherent risks. These include but are not limited to: cold shock response, hyperventilation, sudden cardiac events, loss of consciousness, hypothermia, and in extreme cases death. These risks are elevated in individuals with certain medical conditions. By completing this form you confirm that you have disclosed all relevant health information and that you understand these risks.

Acknowledgements

I acknowledge that I am voluntarily participating in cold water immersion and/or contrast therapy sessions facilitated by Contrast Coach. I understand the nature and purpose of these sessions and confirm that I am physically and mentally fit to participate. I have disclosed all relevant medical conditions, injuries, and medications to the best of my knowledge.

Liability for Property

Contrast Coach and Divers Cove accept no responsibility for loss or damage to personal property brought to or left at the venue during sessions. Participants are responsible for the security of their own belongings.

Release and Indemnity

In consideration of being permitted to participate in these sessions, I agree to release, waive, discharge and hold harmless Contrast Coach (Alan Salter), its employees, volunteers, agents and representatives from any and all claims, demands, losses, costs, expenses, actions and liabilities (including negligence) arising from or in connection with my participation. This release covers all personal injury, illness, death, and property damage whether caused by negligence or otherwise.

Agreement

I confirm that the information I have provided in this form is true and accurate to the best of my knowledge. I understand that withholding or misrepresenting health information may result in risk to my safety and may void any claim against Contrast Coach. I agree to follow all safety guidance provided by the session facilitator at all times.

Severability

If any provision of this waiver is found to be unenforceable or invalid, that provision shall be limited or eliminated to the minimum extent necessary so that this waiver shall otherwise remain in full force and effect and enforceable.

I have read and understood the safety waiver above, and I agree to its terms *

Typed signature (your full name) *

Today's date *

Stay in the loop

Keep me updated about upcoming sessions, events and news from Contrast Coach

Optional. Your health information is never shared or used for marketing purposes. You can unsubscribe at any time.

You're all set.

Your health check has been received. See you at the session.