This Consent Agreement ("Agreement"), effective as of the date below, concerns my  (“I,” “my,” or the "User") use of the “Ammortal Chamber” (or the “Chamber”) provided by Ammortal, Inc. (“Ammortal”) and any related services or treatments. The User hereby agrees to the following:

Important User Acknowledgements 

• I have no electronics in my body: The Ammortal Chamber, along with corresponding services and treatments it performs (individually, "Product" and collectively, "Products") utilizes pulsing electric energy, and this energy can disrupt pacemakers, defibrillators, insulin pumps, implanted cochlear hearing devices and other implants that are battery operated or magnetically charged in or on one's body. I attest that I do not have any such devices in my body, or if so, I will remove such devices before using the Chamber.
• I am at least 18 years old or have parental consent: I confirm that I am at least 18 years of age or, if under 18, my legal parent or guardian will sign on my behalf in order to use the Chamber.
• I have no chemotherapy, illegal narcotics, or alcohol in my system: I confirm I have not undergone chemotherapy within the past 48 hours. I also confirm that I'm not currently under the influence of illegal narcotics or alcohol.
• I am not pregnant, had no recent surgery, and do not weigh over 400lbs: I confirm that I am not currently pregnant. I confirm that I weigh less than 400 pounds (180kg). I confirm that I have not had surgery within 2 weeks and do not have any non-absorbable sutures or staples on my body.
• I do not, to my knowledge, have any of the following: I confirm that I do not knowingly have a severe chronic inflammatory condition, an enclosed infection, hemophilia, a propensity to hemorrhage, seizures, blood clots, a fever, heat sensitivity, or any condition impairing sweating.
• I am not currently taking photosensitizing antibiotics: The Chamber uses red light, and certain antibiotics - including tetracyclines, fluoroquinolones, and sulfonamides - can heighten skin sensitivity to it, leading to rashes, burning, or inflammation. I confirm that I am not currently taking these medications, or that at least 10-14 days have passed since I finished them before using the Chamber.

Important Session Guidance and Rules

• I understand that goggles are available: I have been informed about the option to use protective goggles for sensitive eyes.
• I will keep my hands and feet inside the Chamber: During my session, I will not touch any surface other than the bed surface, although I am aware that, at any time, I can touch the physical button on the vertical support on my left, to exit my session. If I touch anything metal outside the Chamber, during my session, I understand that it may generate an uncomfortable electric zap.
• I will not touch a person or pet during the session: I understand the importance of not allowing any other person, child, or pet to come into contact with me or the Ammortal Chamber during my session. Anyone not inside the Chamber while it is in operation should remain safely outside of contact distance during sessions.
• I will not have a mobile phone or other device on me during my session: I acknowledge that I will at no time, use any electrical device, whether plugged in to a charging port or not, that is not a wearable electronic device like a watch or ring, during an Ammortal Chamber session and will keep my limbs within the confines of the machine during the entire session.
• I will be the only one in the Chamber: I acknowledge that the Ammortal Chamber is a device designed for one individual and not to be used with multiple people inside or with an animal, at any time.
• I understand that any personal data collected will not be shared by Ammortal unless I give consent to use in the case of a testimonial or other requested statement.

I understand that none of the Products, services, treatments, or advice from any employees or contractors are intended to take the place of medical care, medical advice, or medications and/or treatments of any kind. I understand that I take full responsibility for my own health and well-being and acknowledge that the results of Ammortal Products, services, and treatments will vary and that no guarantees of specific results or outcomes are offered or implied.

I acknowledge that neither Ammortal nor any Ammortal staff has made any guarantees or promises as to specific outcomes or efficacy of the Products. I acknowledge and agree that the Ammortal Products may consist in whole or part of experimental procedures and methods, in which no governmental (including the U.S. Food and Drug Administration), scientific, or medical authority has confirmed the safety or efficacy thereof. I understand that the safety and effectiveness of the Products are primarily based on empirical and anecdotal evidence, which only suggests their relative safety and effectiveness. I acknowledge that protocols recommended to me for the Ammortal Products are based on theory and their effect may change from time to time and differ from person to person.      I understand that Ammortal represents and warrants to me that it has all rights, permits, licenses, qualifications, and authority necessary and in accordance with applicable laws to provide the Products, and that Ammortal will maintain, at its own expense, insurance coverages appropriate for the Products and services provided.

I acknowledge that receipt of the Products is at my own risk, but that by initialing and signing this Agreement, I nevertheless acknowledge my willingness to assume such risks and that my consent to the use of the Products is willing, voluntary, and informed. Further, I acknowledge and agree that 113 SPRING NYC INC (“113 Spring”) only provides the venue for the Chamber and the Products, and is not responsible for the design, safety, efficacy, legality, administration, supervision, or provision of the Products, and that Ammortal’s presence at 113 Spring’s location does not constitute an endorsement, sponsorship, or recommendation of the Products by 113 Spring. 113 Spring also does not control, supervise, monitor, evaluate, investigate, or guarantee the quality, legality, accuracy, safety, appropriateness, or effectiveness of Ammortal’s services and expressly disclaims any responsibility or liability relating thereto. I acknowledge and agree that my relationship is solely with Ammortal and not with 113 Spring. I further acknowledge and agree that: (a) Ammortal is not affiliated with, employed by, endorsed by, supervised by, or otherwise associated with 113 Spring; (b) 113 Spring is not a provider of the services described in this Agreement; and (c) any claims, disputes, or issues arising from my interaction with Ammortal are solely between Ammortal and me. I confirm that I have acquainted myself with the contraindications and potential risks associated therewith. I hereby and forever release and discharge and hold harmless Ammortal, 113 Spring, and/or its' distributors, agents, affiliates or subsidiaries from any and all claims, demands, damages, rights of action or causes of action, present or future, arising out of or connected with my use of the Ammortal Chamber, including any injuries, loss and/or death resulting therefrom; provided, however, that the foregoing release of 113 Spring applies only to claims arising from or connected with Ammortal's design, provision, administration, or operation of the Chamber or the Products, and does not release 113 Spring from liability for any claim arising from 113 Spring's own gross negligence or willful misconduct, including in connection with the condition, management, or maintenance of its premises. I acknowledge and agree that 113 Spring is an intended third-party beneficiary of this paragraph, and any other provision that by its terms benefits 113 Spring.

By signing this Agreement, I am releasing and holding harmless Ammortal Inc, 113 Spring, its agents, employees, successors, and assigns from any and all legal, financial, and other liabilities related to all claims, demands, damages, actions, or causes of action arising from or related to my use of the Products. This Agreement is entered into in full settlement and satisfaction of any potential causes of action, claims, or demands. It constitutes the entire understanding between the parties. The terms of this Agreement are contractual and not merely recitals. This Agreement shall be binding upon the User, their heirs, executors, administrators, personaI representatives, successors, and assigns. After carefuI reading and understanding of the terms of this Agreement, the User acknowledges having had adequate time to ask any questions about the Products and willingly assumes all risks associated with their use. This Agreement has been explained to the User and fully understood by them. By signing below, the User confirms their informed consent to the use of the Products. I acknowledge that this Agreement will be governed and construed in accordance with and pursuant to the laws of New York, without giving effect to its principles of conflict of laws.  Any claim, action, or other legal proceeding arising out of or relating to this Agreement will be adjudicated in the state and federal courts sitting in New York.    

This Agreement constitutes my entire understanding with respect to the subject matter herein and supersedes any prior oral or written statements or understandings relating thereto.

User Signature 

By: __________________________

Date: __________________________

Print Name: __________________________

Address: __________________________