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Seedlings Health Declaration

& Activity Acknowledgement

Welcome to Seedlings!

We're excited to share our wellness experiences with you. To ensure all activities are right for you and your safety, please complete this form honestly before participating in Seedlings activities.

This form must be completed before participation.

Your Contact & Personal Details

Birthday
Day
Month
Year

Medical Information

The following medical questions are important for your safety across all offered activities including heat, cold, breathwork, and light fitness.

Do you suffer from, or have you ever been diagnosed with, High Blood Pressure?
Yes
No
Do you suffer from, or have you ever been diagnosed with, Low Blood Pressure that causes symptoms (e.g., fainting, dizziness)?
Yes
No
Have you ever suffered any form of epilepsy or seizure?
Yes
No
Have you had any surgery in the last three months?
Yes
No
Are you currently pregnant?
Yes
No
Do you suffer from, or have you ever been diagnosed with, Raynaud's disease or another severe circulatory disorder?
Yes
No
Do you suffer from, or have you ever been diagnosed with, glaucoma?
Yes
No
Do you suffer from, or have you ever been diagnosed with, a heart condition (e.g., angina, heart disease, arrhythmias, pacemaker)?
Yes
No
Do you have a history of stroke?
Yes
No
Do you suffer from any form of anxiety?
Yes
No
Have you ever suffered from any blood clots (e.g., DVT, PE)?
Yes
No
Do you suffer from asthma or any other respiratory conditions (e.g., COPD, hyperventilation) that might be affected by these activities?
Yes
No
Do you have any recent physical injuries (e.g., sprains, fractures, open wounds)?
Yes
No
Are you currently taking any prescribed medication?
Yes
No
Do you have any other pre-existing medical condition not listed above, or have been feeling unwell, that you believe could affect your ability to safely participate in cold water therapy, heat therapy, breathwork, or physical exertion?
Yes
No

Important Information, Acknowledgements & Waivers

IMPORTANT – PLEASE READ CAREFULLY

Participation in cold water therapy (chill tank approx. 15°C, ice bath approx. 10°C and below), heat therapy (sauna approx. 75°C upwards, hot tub approx. 37-40°C), breathwork, and fitness activities with Jennifer Bailey-Hobbs/Seedlings Retreats & Holidays and their instructors or facilitators involves inherent risks.


Potential Risks:

You acknowledge that these activities can be inherently dangerous. While participating, you are at risk of suffering physical harm or personal injury, including but not limited to broken bones, soft tissue injuries, permanent disability, or even death. These injuries may occur from many causes, including (but not limited to): slipping on wet surfaces; colliding with equipment or another person; incorrect use of equipment; or engaging in strenuous exercise, breathwork, or hot/cold exposure.


Your Responsibility & Medical Fitness:

  • You participate voluntarily, at your own risk.

  • You are responsible for your wellbeing, listening to your body, and stopping if you are unwell.

  • Inform us immediately of any adverse effects.

  • This is not medical advice.

  • Consult your doctor before any new activity, especially with pre-existing conditions or if on medication.

  • Honestly declare your health status.

  • Follow all instructions.


Specific Activity Risks Acknowledged:

  • Cold Water Immersion/Ice Bath: You acknowledge and accept the risks associated with cold water immersion, including but not limited to cold shock, after-drop, potential for hypothermia, and cardiovascular stress, which in extreme cases could lead to serious injury or death.

  • Breathwork: You acknowledge and accept that breathwork can be a powerful practice resulting in intense physical/emotional experiences (e.g., tingling, dizziness, altered states). It is not recommended for those with specific conditions like aneurysms, uncontrolled epilepsy, or severe psychiatric conditions (refer to contraindications), which could lead to adverse health events.

  • Heat Therapy (Sauna/Hot Tub): You acknowledge and accept the risks of heat exposure, including but not limited to dehydration, overheating, fainting, and potential cardiovascular stress, especially for individuals with pre-existing health conditions, which in some circumstances could lead to serious health issues.

  • Fitness Activities (e.g., light movement, yoga, walks): You acknowledge and accept that physical activity carries inherent risks of injury, including, but not limited to, muscle strains, sprains, joint issues, or falls, particularly if you have pre-existing physical limitations or injuries, which could result in varying degrees of harm up to and including serious injury or permanent disability.


Liability, Possessions & Indemnity:

To the fullest extent permitted by law, you release Jennifer Bailey-Hobbs/Seedlings Retreats & Holidays and their instructors/facilitators from all liability for any injury (including permanent disability), death, loss, or damage arising from your participation, including due to negligence. You assume all risks. You are responsible for your belongings; we are not liable for loss/damage. If you damage equipment, you are liable for repair/replacement costs. You agree to indemnify Seedlings for any medical or legal costs arising from your participation related to such injury, death, loss, or damage.

Health & Safety Acknowledgement

(Specific Contraindications)

By proceeding with your booking/participation, you confirm that you have:

  • Completed this Health Declaration Form accurately.

  • Read and understood the potential risks associated with sauna, cold immersion, heat therapy, breathwork, and fitness activities.

  • Declared any relevant medical conditions and have been medically cleared by a doctor, where necessary.

  • Accepted full responsibility for your participation and agreed to exit the experience if you feel unwell at any time.

  • Agree to follow the directions of your instructor and take reasonable care whilst on the premises to avoid injury.


Absolute Contraindications (Do Not Use without prior medical clearance from your Doctor):

Please do not use the sauna, hot tub, chill tank, or ice bath, or participate in strenuous breathwork or fitness if you have any of the following conditions, unless you have explicit medical clearance from your doctor:

  • Uncontrolled high or low blood pressure

  • Serious cardiovascular conditions (including but not limited to heart disease,

  • arrhythmias, use of a pacemaker)

  • History of stroke

  • Epilepsy or seizure disorders (uncontrolled or where advised against by a doctor)

  • Recent surgery (within the last 3 months or as advised by your surgeon)

  • Raynaud’s disease or other severe cold-induced circulatory disorders

  • Pregnancy

  • Current fever, acute infection, or contagious illness

  • Under the influence of alcohol or drugs that impair judgment or physical ability


Jennifer Bailey-Hobbs/Seedlings Retreats & Holidays accepts no liability for adverse effects resulting from undeclared conditions or failure to follow guidance.

Confirmation & Agreement:

By signing this document, I certify that the information I have provided is correct and true. I confirm that I have read, understood, and agreed to all the terms, acknowledgements, waivers, and releases of liability contained in this document, including the risks of serious injury, permanent disability, or death.


I agree to participate in cold water therapy, heat therapy, breathwork, and fitness activities offered by Jennifer Bailey-Hobbs/Seedlings Retreats & Holidays and its instructors or facilitators at my own risk and take full responsibility for any injuries, ailments, or loss/damage to personal possessions that may occur.

Consent & Signature

Date
Day
Month
Year

Privacy Statement: Your personal information is treated with care. For details on how we handle your data, please see our Privacy Policy.



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