Clone of Fu Zu Ba Student Massage Clinic Registration Form

FU ZU BA School Student Clinic Customer Registration Form
Read and check*

Student clinic is performed by training students and supervised by instructors. Students shall not accept any compensation for this service.
Read and Check*

Student massage trainees will be appointed to you by instructors. 学生按摩师由老师指定.
Read and Check*

All student massage clinic will be conducted at the classroom site.
Read and Check*

I understand that I may not be treated if I have contra-indications. You may consult with the supervising instructor if not sure.
Internal Use Only
Registration must be completed and signed online by the customer
Customer Name*

First NameMiddle NameLast Name
Customer E-mail*
Mobile Number*
Format: (000) 000-0000.
Appointment*
My Products
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Reflexology 45-min

$30.00



Swedish Massage 60-min

$50.00



Deep Tissue Massage 110-min

$80.00



Total

$0.00
Additional Comments
Signature*
Human verification*
Should be Empty:

FU ZU BA School Student Clinic Customer Registration Form