Animal Waiver Form

Today's Date*

Date

Owner's Name*

First NameLast Name

E-mail*

example@example.com

Mobile #*

Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Animal's Species*

Animal's Name*

Animal's sex*

Animal's Age*

Start Date of Treatment blank
End Date of Treatment blank

Animal been or being treated for*

Veterinarian & Contact Info

Current Medications*

Please write n/a if not applicable

MagnaWave PEMF creates more cell permeability, this medicationsand liniments may be absorbed more than intended.

Reason for Visit*

Are you interested in speaking with a product specialist?*

YesNo

I am over 18 years of age.*

Yes

Signature Signature

* By completing this form you agree to the terms listed on this PEMF Session Release Waiver: I hereby state that I am at least 18 years of age and have read, understand and agree to this Release Statement, that it is an informed release and that I intend to be legally bound by it. I understand the information below is intended for my safety and that of my horse(s), bovine(s) etc.

No one has made any representations or claims to me of any treatment or cure of any disease or condition; or any promise of any specific or general results of any kind.

I release from all general, medical and any other liability or claims of any kind; and,
I indemnify and hold harmless the MagnaWave magnetic pulse generator, the manufacturer, distributor, dealer and any of their employees or agents from any claim arising from or related to my use of the magnetic pulse generator.

and the Photo & Video Release Form: I hereby authorize NJ Wellness PEMF, to take photos/videos regarding my experiences with them. I grant them to use my photos/videos on social media platforms and other marketing materials. I allow them to edit, alter, copy, or distribute the content for advertising and marketing purposes. I understand that I will not receive any monetary compensation.

You are opting in to promotional text 5Msgs/Month.

Large Animal & Livestock Waiver Form