3 Waiver Form

I would like to acknowledge Michelle DeRouen of Float Houston for the majority of this text.

We make all reasonable efforts to ensure a comfortable, clean, and safe environment for you. As such, you may be provided the opportunity of using our floatation tanks. Please read over the following information and sign your name and date at the bottom of the form to indicate your agreement and adherence with our policies and procedures.

  1. I will NOT use the isolation (aka floatation tank, sensory deprivation tank):
    1. With oils or creams on my body.
    2. If I have any communicable or infectious disease or illness, skin disorder, large cuts, open sores or wounds.
    3. I am under the influence of alcohol or drugs.
    4. If I am epileptic, unless in the opinion of my physician my epilepsy is under medical control so that I am in sufficient control of my seizures not to endanger myself in the floatation tank.
    5. If I am pregnant and have NOT received permission to float from my health-care provider.
    6. If I suffer from any claustrophobic or small or enclosed space anxiety-provoking disorders.
    7. If I suffer from diabetes, unless, in the opinion of my physician, my diabetes is under medical control so that I am in sufficient safety to use the floatation tank.
    8. If I suffer or have suffered from chronic heart disease, unless, in the opinion of my physician, my chronic heart disease in under medical control so that I am in sufficient safety to use the floatation tank.
  2. I further understand that the floatation tank uses Epsom salt (magnesium sulfate) and either hydrogen peroxide or chlorine cleaning products which will be in the water and that some people may experience skin allergies or reactions to such chemicals.
  3. I also hereby agree and understand that I shall have consulted with my own healthcare provider prior to using the floatation tank if I am currently taking any medication or under a physician’s care for any reason.
  4. Upon using this floatation tank, I absolve this Gnostic Isolation Temple and its Abba(s) as well as Isolation Tank Gnosis and all of its officers from any and all liability in connection with use thereof whether such loss or damage be direct or indirect.
  5. I further agree to take full responsibility for my thoughts and actions while in the floatation tank and the waiver of liability and all agreements made herein shall apply to each use I make of the floatation tank.
  6. The Abba has covered the 7 logistical issues with me. I understand that the Abba is not being mean to me by not speaking when I exit. To the contrary, they simply want me to remain in my own space as much as possible. I realize that I can initiate conversation with the Abba. I also realize that I can leave in silence.

 

Signature of Recluse  ________________________________________________________________

Date: ________________