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FULL POTENTIAL, INC recommends that you clear your participation in any of our programs with your physician.

INFORMED CONSENT/ASSUMPTION OF RISK

By signing this agreement I agree to the use of the facilities and amenities and agree to all policies and rules set forth by FULL POTENTIAL, INC and/or Daniel Vadala (hereinafter collectively referred to as FULL POTENTIAL).  FULL POTENTIAL made me fully aware that the programs, facilities, and amenities which FULL POTENTIAL offers and in which I desire to participate are of a nature and kind that are extremely strenuous and can/may push me to the limits of my physical abilities. I the undersigned recognize and understand that these activities are not without varying degrees of risk which may include, but are not limited to the following:

Injury to the musculoskeletal and/or cardio respiratory systems which can result in serious injury or death, injury or death due to negligence on the part of myself, or other people around me, injury or death due to improper use or failure of equipment, or injury or death due to a medical condition, whether known or unknown by me. I am aware that any of these above mentioned risks may result in serious injury, illness or death to myself.


I willingly assume full responsibility for any and all risks that I am exposing myself to as a result of my use of sauna, cold plunge, and all related facilities and amenities, and accept full responsibility for any injury, illness or death that may result from participation and use of said facilities and amenities. I herby certify that I know of no medical problems that would increase my risk of illness and injury as a result of said use. FULL POTENTIAL informed me that there exists the possibility of adverse physical changes due to my participation, and I fully understand the same. FULL POTENTIAL informed me that these changes could include but are not limited to heat and/or cold related illnesses, abnormal blood pressure, fainting, disorder of heart rhythm, stroke, and in very rare instances, heart attack or even death, and I fully understand the same. With my full understanding of the above information, I agree to assume any and all risk associated with my participation and use of FULL POTENTIAL facilities and amenities.


Additional Assumption of Risk. Participation in the Activity involves inherent risks, including the risk of injury, as well as the risks associated with exposure to heat and to cold.  

The sauna can reach temperatures of up to 151℉. The cold plunge can reach temperatures as low as 32℉. The FULL POTENTIAL amenities could result in illness, injury or death including but not limited to frostbite, hypothermia, hyperthermia, heat exhaustion and stroke, and slipping and falling. Other potential injuries could include but are not limited to: dehydration, injuries caused by fainting, heat stress, heat stroke, dermal and subdermal burns, musculoskeletal injuries, head injuries, cardio respiratory stress, sprains, broken bones, dislocations, head injuries, other serious injury, paralysis, and death. These injuries could also be caused by the malfunction of the equipment, improper maintenance of the equipment, inadequate instructions and or warnings, or the NEGLIGENCE of FULL POTENTIAL or the participation of another user in the Activity. 


Release: 

In full consideration of the above mentioned risks and hazards and in full consideration of the fact that I am willingly and voluntarily participating in the activities made available by FULL POTENTIAL, and with my full understanding of all of the above, I hereby waive, release, remise and discharge FULL POTENTIAL and its agents, officers, principals and employees and volunteers, of any and all liability, claims, demands, actions or rights of action, or damages of any kind related to, arising from, or in any way connected with, my participation at FULL POTENTIAL, including those allegedly attributed to the negligent acts or omissions of the above mentioned parties.

This agreement shall be binding upon me, my successors, representatives, heirs, executors, assigns, or transferees. If any portion of this agreement is held invalid, I agree that the remainder of the agreement shall remain in full legal force and effect.

I acknowledge that no minors are allowed to use the sauna or cold plunge at any time and certify that I am 18 years of age or older.


Indemnification: I recognize that there is risk involved in the types of activities offered by FULL POTENTIAL. Therefore I accept financial responsibility for any injury or illness that I may cause either to myself or to any other participant due to my negligence. Should the above mentioned parties, or anyone acting on their behalf, be required to incur attorney’s fees and costs to enforce this agreement, I agree to reimburse them for such fees and costs. I further agree to indemnify and hold harmless FULL POTENTIAL, their principals, agents, employees, and volunteers from liability for the injury or death of any person(s) and damage to property that may result from my negligent or intentional act or omission while participating in activities offered by FULL POTENTIAL. 


I have fully read and fully understand the foregoing assumption of risk, and release of liability and I understand that by signing it obligates me to indemnify the parties named for any liability for injury, illness or death of any person and damage to property caused by my negligent or intentional act or omission. I understand that by signing this form I am waiving valuable legal rights.

Signature of Participant:

Date: May 9, 2024

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

HEALTH ASSESSMENT

Have you ever had any form of heart disease?*
No
Yes
Have you ever experienced shortness of breath or chest pains?*
No
Yes

Date of last full physical:

Do you have or do any of the following pertain to your heath?

If yes please explain.

High Blood Pressure?*
No
Yes

Levels:
Cigarette Smoking?*
No
Yes
Diabetes?*
No
Yes

Types:
Family History of Heart Disease?*
No
Yes

Who/Age:
Do you work out at least three times per week?*
No
Yes
Are you currently taking any medication?*
No
Yes

Explain:

Do you have problems in the following areas?

Knees*
No
Yes

Explain:
Lower Back*
No
Yes

Explain:
Neck/Shoulders*
No
Yes

Explain:
Hip/Pelvis*
No
Yes

Explain:
Any Other*
No
Yes

Explain:
Is there any reason you know of that you should not use or participate in any of the FULL POTENTIAL classes, programs, amenities, or facilities? *
No
Yes

Explain:
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

HEALTH ASSESSMENT

Have you ever had any form of heart disease?*
No
Yes
Have you ever experienced shortness of breath or chest pains?*
No
Yes

Date of last full physical:

Do you have or do any of the following pertain to your heath?

If yes please explain.

High Blood Pressure?*
No
Yes

Levels:
Cigarette Smoking?*
No
Yes
Diabetes?*
No
Yes

Types:
Family History of Heart Disease?*
No
Yes

Who/Age:
Do you work out at least three times per week?*
No
Yes
Are you currently taking any medication?*
No
Yes

Explain:

Do you have problems in the following areas?

Knees*
No
Yes

Explain:
Lower Back*
No
Yes

Explain:
Neck/Shoulders*
No
Yes

Explain:
Hip/Pelvis*
No
Yes

Explain:
Any Other*
No
Yes

Explain:
Is there any reason you know of that you should not use or participate in any of the FULL POTENTIAL classes, programs, amenities, or facilities? *
No
Yes

Explain:
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

HEALTH ASSESSMENT

Have you ever had any form of heart disease?*
No
Yes
Have you ever experienced shortness of breath or chest pains?*
No
Yes

Date of last full physical:

Do you have or do any of the following pertain to your heath?

If yes please explain.

High Blood Pressure?*
No
Yes

Levels:
Cigarette Smoking?*
No
Yes
Diabetes?*
No
Yes

Types:
Family History of Heart Disease?*
No
Yes

Who/Age:
Do you work out at least three times per week?*
No
Yes
Are you currently taking any medication?*
No
Yes

Explain:

Do you have problems in the following areas?

Knees*
No
Yes

Explain:
Lower Back*
No
Yes

Explain:
Neck/Shoulders*
No
Yes

Explain:
Hip/Pelvis*
No
Yes

Explain:
Any Other*
No
Yes

Explain:
Is there any reason you know of that you should not use or participate in any of the FULL POTENTIAL classes, programs, amenities, or facilities? *
No
Yes

Explain:
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

HEALTH ASSESSMENT

Have you ever had any form of heart disease?*
No
Yes
Have you ever experienced shortness of breath or chest pains?*
No
Yes

Date of last full physical:

Do you have or do any of the following pertain to your heath?

If yes please explain.

High Blood Pressure?*
No
Yes

Levels:
Cigarette Smoking?*
No
Yes
Diabetes?*
No
Yes

Types:
Family History of Heart Disease?*
No
Yes

Who/Age:
Do you work out at least three times per week?*
No
Yes
Are you currently taking any medication?*
No
Yes

Explain:

Do you have problems in the following areas?

Knees*
No
Yes

Explain:
Lower Back*
No
Yes

Explain:
Neck/Shoulders*
No
Yes

Explain:
Hip/Pelvis*
No
Yes

Explain:
Any Other*
No
Yes

Explain:
Is there any reason you know of that you should not use or participate in any of the FULL POTENTIAL classes, programs, amenities, or facilities? *
No
Yes

Explain:
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

HEALTH ASSESSMENT

Have you ever had any form of heart disease?*
No
Yes
Have you ever experienced shortness of breath or chest pains?*
No
Yes

Date of last full physical:

Do you have or do any of the following pertain to your heath?

If yes please explain.

High Blood Pressure?*
No
Yes

Levels:
Cigarette Smoking?*
No
Yes
Diabetes?*
No
Yes

Types:
Family History of Heart Disease?*
No
Yes

Who/Age:
Do you work out at least three times per week?*
No
Yes
Are you currently taking any medication?*
No
Yes

Explain:

Do you have problems in the following areas?

Knees*
No
Yes

Explain:
Lower Back*
No
Yes

Explain:
Neck/Shoulders*
No
Yes

Explain:
Hip/Pelvis*
No
Yes

Explain:
Any Other*
No
Yes

Explain:
Is there any reason you know of that you should not use or participate in any of the FULL POTENTIAL classes, programs, amenities, or facilities? *
No
Yes

Explain:
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

HEALTH ASSESSMENT

Have you ever had any form of heart disease?*
No
Yes
Have you ever experienced shortness of breath or chest pains?*
No
Yes

Date of last full physical:

Do you have or do any of the following pertain to your heath?

If yes please explain.

High Blood Pressure?*
No
Yes

Levels:
Cigarette Smoking?*
No
Yes
Diabetes?*
No
Yes

Types:
Family History of Heart Disease?*
No
Yes

Who/Age:
Do you work out at least three times per week?*
No
Yes
Are you currently taking any medication?*
No
Yes

Explain:

Do you have problems in the following areas?

Knees*
No
Yes

Explain:
Lower Back*
No
Yes

Explain:
Neck/Shoulders*
No
Yes

Explain:
Hip/Pelvis*
No
Yes

Explain:
Any Other*
No
Yes

Explain:
Is there any reason you know of that you should not use or participate in any of the FULL POTENTIAL classes, programs, amenities, or facilities? *
No
Yes

Explain:
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

HEALTH ASSESSMENT

Have you ever had any form of heart disease?*
No
Yes
Have you ever experienced shortness of breath or chest pains?*
No
Yes

Date of last full physical:

Do you have or do any of the following pertain to your heath?

If yes please explain.

High Blood Pressure?*
No
Yes

Levels:
Cigarette Smoking?*
No
Yes
Diabetes?*
No
Yes

Types:
Family History of Heart Disease?*
No
Yes

Who/Age:
Do you work out at least three times per week?*
No
Yes
Are you currently taking any medication?*
No
Yes

Explain:

Do you have problems in the following areas?

Knees*
No
Yes

Explain:
Lower Back*
No
Yes

Explain:
Neck/Shoulders*
No
Yes

Explain:
Hip/Pelvis*
No
Yes

Explain:
Any Other*
No
Yes

Explain:
Is there any reason you know of that you should not use or participate in any of the FULL POTENTIAL classes, programs, amenities, or facilities? *
No
Yes

Explain:
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

HEALTH ASSESSMENT

Have you ever had any form of heart disease?*
No
Yes
Have you ever experienced shortness of breath or chest pains?*
No
Yes

Date of last full physical:

Do you have or do any of the following pertain to your heath?

If yes please explain.

High Blood Pressure?*
No
Yes

Levels:
Cigarette Smoking?*
No
Yes
Diabetes?*
No
Yes

Types:
Family History of Heart Disease?*
No
Yes

Who/Age:
Do you work out at least three times per week?*
No
Yes
Are you currently taking any medication?*
No
Yes

Explain:

Do you have problems in the following areas?

Knees*
No
Yes

Explain:
Lower Back*
No
Yes

Explain:
Neck/Shoulders*
No
Yes

Explain:
Hip/Pelvis*
No
Yes

Explain:
Any Other*
No
Yes

Explain:
Is there any reason you know of that you should not use or participate in any of the FULL POTENTIAL classes, programs, amenities, or facilities? *
No
Yes

Explain:
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

HEALTH ASSESSMENT

Have you ever had any form of heart disease?*
No
Yes
Have you ever experienced shortness of breath or chest pains?*
No
Yes

Date of last full physical:

Do you have or do any of the following pertain to your heath?

If yes please explain.

High Blood Pressure?*
No
Yes

Levels:
Cigarette Smoking?*
No
Yes
Diabetes?*
No
Yes

Types:
Family History of Heart Disease?*
No
Yes

Who/Age:
Do you work out at least three times per week?*
No
Yes
Are you currently taking any medication?*
No
Yes

Explain:

Do you have problems in the following areas?

Knees*
No
Yes

Explain:
Lower Back*
No
Yes

Explain:
Neck/Shoulders*
No
Yes

Explain:
Hip/Pelvis*
No
Yes

Explain:
Any Other*
No
Yes

Explain:
Is there any reason you know of that you should not use or participate in any of the FULL POTENTIAL classes, programs, amenities, or facilities? *
No
Yes

Explain:
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

HEALTH ASSESSMENT

Have you ever had any form of heart disease?*
No
Yes
Have you ever experienced shortness of breath or chest pains?*
No
Yes

Date of last full physical:

Do you have or do any of the following pertain to your heath?

If yes please explain.

High Blood Pressure?*
No
Yes

Levels:
Cigarette Smoking?*
No
Yes
Diabetes?*
No
Yes

Types:
Family History of Heart Disease?*
No
Yes

Who/Age:
Do you work out at least three times per week?*
No
Yes
Are you currently taking any medication?*
No
Yes

Explain:

Do you have problems in the following areas?

Knees*
No
Yes

Explain:
Lower Back*
No
Yes

Explain:
Neck/Shoulders*
No
Yes

Explain:
Hip/Pelvis*
No
Yes

Explain:
Any Other*
No
Yes

Explain:
Is there any reason you know of that you should not use or participate in any of the FULL POTENTIAL classes, programs, amenities, or facilities? *
No
Yes

Explain:
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

HEALTH ASSESSMENT

Have you ever had any form of heart disease?*
No
Yes
Have you ever experienced shortness of breath or chest pains?*
No
Yes

Date of last full physical:

Do you have or do any of the following pertain to your heath?

If yes please explain.

High Blood Pressure?*
No
Yes

Levels:
Cigarette Smoking?*
No
Yes
Diabetes?*
No
Yes

Types:
Family History of Heart Disease?*
No
Yes

Who/Age:
Do you work out at least three times per week?*
No
Yes
Are you currently taking any medication?*
No
Yes

Explain:

Do you have problems in the following areas?

Knees*
No
Yes

Explain:
Lower Back*
No
Yes

Explain:
Neck/Shoulders*
No
Yes

Explain:
Hip/Pelvis*
No
Yes

Explain:
Any Other*
No
Yes

Explain:
Is there any reason you know of that you should not use or participate in any of the FULL POTENTIAL classes, programs, amenities, or facilities? *
No
Yes

Explain:
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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