Chair Massage Registration Form

Chair Massage Registration Form

SHAPESHIFT STUDIO by Amy Stanley, LMT, SI, MLD-C, NKT1
DESCRIPTION

This chair massage can include the neck, shoulders, arms, back, and scalp. It is designed for relaxation, stress reduction, and tension relief. 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, 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: