MK Head & Scalp Spa
Client Waiver, Release of Liability & Informed Consent
Business Name:
MK Head & Scalp Spa ("Spa")
Website:
mkhead.com
Client Information
Full Name:
First Name
Last Name
Phone:
Email:
example@example.com
Date of Birth:
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Month
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Day
Year
Date
Initial Date of Service:
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Month
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Day
Year
Date
Description of Services
I understand that MK Head & Scalp Spa provides head spa, scalp care, shampoo, massage, and related relaxation and wellness services ("Services"). These Services are provided solely for relaxation and general wellness purposes and are not medical treatment, physical therapy, or a substitute for professional medical care.
Health Disclosure & Client Responsibilities
I certify that I have disclosed all relevant medical conditions, including but not limited to scalp or skin conditions, open wounds, infections, allergies or sensitivities (including products, fragrances, or oils), recent surgeries, injuries, chronic conditions, pregnancy, or any condition that may require modification of the Services. I understand that failure to disclose relevant health information may increase the risk of adverse reactions, and I accept full responsibility for such risks.
Assumption of Risk
I understand and acknowledge that the Services may involve risks, including but not limited to skin irritation, allergic reactions, dizziness, soreness, tenderness, or discomfort. I voluntarily assume all risks, known and unknown, associated with receiving the Services.
Release of Liability
To the fullest extent permitted by law, I hereby release, waive, discharge, and hold harmless MK Head & Scalp Spa, its owners, employees, contractors, and agents from any and all claims, demands, damages, losses, or causes of action arising out of or related to the Services, except in cases of gross negligence or willful misconduct.
No Sexual Conduct Policy
I understand and agree that no sexual services or conduct are provided or permitted at MK Head & Scalp Spa. Any inappropriate behavior, requests, gestures, or actions will result in immediate termination of the Service without refund and may be reported to authorities.
Consent to Treatment
I consent to receive the Services and understand that I may stop or request modifications at any time during the session. I acknowledge that results may vary and that no guarantees have been made.
Waiver Validity & Future Visits
This Waiver & Release shall remain valid for a period of
twelve (12) months
from the date of signature and shall apply to all current and future Services provided by the Spa during that time, unless revoked in writing. I agree to notify the Spa of any changes to my health condition prior to any future visit.
Repeat Visit Health Confirmation
For each subsequent visit within the validity period, I acknowledge that I may be asked to confirm that my health
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information has not changed since my last visit.
Photography & Media (Optional)
Photography & Media Consent
*
I consent to photographs or videos being taken for marketing or educational purposes.
I do not consent to photographs or videos.
Governing Law
This Agreement shall be governed by and construed in accordance with the laws of the State of Illinois.
Acknowledgment & Signature
I certify that I have read and fully understand this Waiver & Release, and I sign it voluntarily.
Client Signature:
Printed Name:
Date:
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Month
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Year
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Spa Representative (Optional):
Date:
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Month
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Day
Year
Date
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