Recovery Lounge Waiver & Release
for participants under 18
Foundry Collective SRQ • In-Store Compression Boot Sessions
(Parent/Legal Guardian must complete and sign.)
NOTICE TO THE MINOR CHILD’S NATURAL GUARDIAN
READ THIS FORM COMPLETELY AND CAREFULLY. YOU ARE AGREEING TO LET YOUR MINOR CHILD ENGAGE IN A POTENTIALLY DANGEROUS ACTIVITY. YOU ARE AGREEING THAT, EVEN IF [FOUNDRY COLLECTIVE SRQ] USES REASONABLE CARE IN PROVIDING THIS ACTIVITY, THERE IS A CHANCE YOUR CHILD MAY BE SERIOUSLY INJURED OR KILLED BY PARTICIPATING IN THIS ACTIVITY BECAUSE THERE ARE CERTAIN DANGERS INHERENT IN THE ACTIVITY WHICH CANNOT BE AVOIDED OR ELIMINATED. BY SIGNING THIS FORM YOU ARE GIVING UP YOUR CHILD’S RIGHT AND YOUR RIGHT TO RECOVER FROM [FOUNDRY COLLECTIVE SRQ] IN A LAWSUIT FOR ANY PERSONAL INJURY, INCLUDING DEATH, TO YOUR CHILD OR ANY PROPERTY DAMAGE THAT RESULTS FROM THE RISKS THAT ARE A NATURAL PART OF THE ACTIVITY. YOU HAVE THE RIGHT TO REFUSE TO SIGN THIS FORM, AND [FOUNDRY COLLECTIVE SRQ] HAS THE RIGHT TO REFUSE TO LET YOUR CHILD PARTICIPATE IF YOU DO NOT SIGN THIS FORM.
Service: Recovery Lounge compression boot session (15-30 minutes)
1) Service Description (Non-Medical)
The Recovery Lounge provides non-medical pneumatic compression boot sessions (10–15 minutes) intended for temporary relief of leg fatigue and relaxation. It is not medical care or a substitute for advice from a clinician.
2) Health Screening for Minor (parent/guardian completes)
If YES to any item below, do not proceed today without clinician clearance. Please assess the options below (no need to select).
☐ YES ☐ NO History of DVT/blood clots, clotting disorders, or pulmonary embolism
☐ YES ☐ NO Cardiovascular disease not well-controlled (incl. uncontrolled hypertension)
☐ YES ☐ NO Recent surgery (within 6 weeks) or acute injury to legs/feet
☐ YES ☐ NO Open wounds, active infection, severe varicose veins with skin changes, or active cellulitis
☐ YES ☐ NO Neuropathy or impaired sensation
☐ YES ☐ NO Any clinician advice against compression for your child
Socks required. Tell staff immediately if your child feels pain, numbness, tingling, dizziness, shortness of breath, or discomfort; we will stop the session.
3) Assumption of Risk (by Parent/Guardian)
I understand there are inherent risks (temporary discomfort, skin irritation, lightheadedness, rare adverse events). On behalf of my child, I voluntarily assume all such risks.
4) Release of Liability (Ordinary Negligence Only; Florida)
To the fullest extent permitted by Florida law, I, as natural parent/legal guardian, release and discharge Foundry Collective SRQ, its owners, contractors, employees, and agents from claims arising from ordinary negligence related to my child’s participation. This release does not waive claims for gross negligence or intentional misconduct.
5) Indemnification & Hold Harmless
Except to the extent caused by gross negligence or intentional misconduct of the released parties, I agree to indemnify and hold harmless Foundry Collective SRQ from claims or expenses arising out of my child’s participation.
6) Photos/Video of Minor (optional)
Please select your preference in the form below.
7) Acknowledgment
I am the natural parent/legal guardian. I have read and understand this consent & waiver and sign voluntarily.
Parent/Guardian Signature: ____________________________ Date: //______
Printed Name: ________________________________________ Relationship: ___________