Chair Massage Registration Form

Chair Massage Registration Form
DESCRIPTION
This upper-body chair massage includes the neck, shoulders, arms, back, and scalp. It is designed for relaxation and stress reduction. It should not be used as a replacement for any medical care.
LIABILITY RELEASE STATEMENT
By filling and signing this form, I, hereby, declare that I read and understand the chair massage description and I am voluntarily participating in the chair massage program. In consideration for my acceptance into the program, I hereby for myself, my heirs, executors, administrators, and assignees waive and release all rights and claims from any and all injuries or damages.
Name
First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Do you have a current or past medical conditions or injuries?
NoYes
Please describe:
Appointment
Date
MonthDayYear
Date
Signature
Clear
Should be Empty: