Services:
I acknowledge and agree to receive, or approve for the person under 18 who I am parent/ guardian of, the following treatment(s) provided by NXT LVL: Localized Cryotherapy, Dynamic Compression, Stretching, Therapeutic Massage/ Soft Tissue Mobilization, Cupping, and/or Scraping. I understand that these services are provided for the purposes of improving sports recovery, decreasing pain, reducing muscle soreness, and enhancing performing. I understand that these benefits cannot be guaranteed.
Medical Considerations:
I understand and agree to disclose any relevant medical history or conditions to NXT LVL. I acknowledge that I, or the person under 18 who I am parent/ guardian of, do not have any medical conditions or history that would impact or prevent me from receiving the service(s) requested such as the conditions on the Contraindications and Precautions sheet. In the event of any medical emergency or adverse reaction during the treatments, I authorize NXT LVL to seek emergency medical treatment on my behalf and to notify my emergency contact, if provided.
Assumption of Risk:
I understand that the treatments provided by NXT LVL involve certain inherent risks, including but not limited to:
1. Potential discomfort or soreness during or after the treatment.
2. Risks associated with localized cryotherapy, such as frostbite or skin irritation.
3. Risks associated with dynamic compression, such as muscle soreness, discomfort, bruising, or fatigue.
4. Risks associated with stretching, therapeutic massage, cupping, and scraping such as muscle soreness, strain, or bruising.
I hereby assume all risks associated with these treatments and consent to proceed with the services offered by NXT LVL.
Confidentiality:
I understand that personal health information and treatment records will be kept confidential and will not be disclosed to any third party without explicit consent, except as required by law.
Release of Liability:
In consideration of the services provided, I, on behalf of myself and my heirs, executors, administrators, and assigns, hereby release, waive, discharge, and hold harmless NXT LVL, its owners, employees, contractors, and representatives from any and all claims, demands, actions, or liabilities arising out of or related to the treatment(s) received.
Consent for Treatment:
I understand that the treatments provided are not a substitute for medical care. I understand there is no guarantee that expected or anticipated results will be achieved. I am voluntarily seeking the treatment(s) requested and understand I have the right to refuse or stop treatment at any time and for any reason. Personnel from NXT LVL will be present during the entire treatment.
I hereby give my consent to NXT LVL to administer the requested treatment(s) listed above. I understand that payment is due at time of service and that there are no refunds. Persons under 18 years of age require parent or guardian permission to receive service(s).
Media Consent
I agree for NXT LVL, LLC to use pictures and/ or videos of myself and service(s) received for social media, training, and/ or other purposes. I must explicitly tell NXT LVL if I do not consent to media use.
To be completed by parent/ guardian if athlete is under 18 years of age
I agree to terms & conditions provided by NXT LVL. By providing my contact information, I agree to receive communications from NXT LVL. I understand I can opt out at anytime.
Agreement:
I have read and understood the contents of this waiver and consent form. I voluntarily and knowingly accept the terms and conditions outlined herein. By submitting this form, I acknowledge that I am at least 18 years old or am giving permission for the person under 18 I am parent or guardian of, to receive services from NXT LVL.