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Name
Before you see Hanan for Thai Massages, please fill out the form above to agree to the waiver Agreement. In the Comment box, write “agree” and write your full name as an e-signature.

LIABILITY WAIVER AGREEMENT

I _______________________________________(Receiver) understand that Thai yoga bodywork (bodywork) involves acupressure, trigger point release and passive stretching to soften and lengthen muscles and myofascial tissue thereby increasing circulation and range of motion.  This may also be an opportunity for relaxation, stress reduction and relief from muscular pain.  However, this is an individual experience and as such Hanan Palz makes no guarantees of outcome.   There is also a risk of injury and even pain.

My signature acknowledges that I have discussed prior injuries and illnesses with Hanan Palz.  Furthermore, if I experience any pain or discomfort above a 5 (using a range of 1 as lowest and 10 at highest) I will listen to my body and ask Hanan Palz to make an adjust to the intensity or ask for additional support.  This bodywork is not a substitute for medical attention, examination, diagnosis or treatment.  There are some contraindications to receiving bodywork and I hereby acknowledge that I have made any concerns known to Hanan Palz.

I affirm that I alone am responsible to decide whether to receive bodywork. I hereby agree to irrevocably release and waive any claims that I have now or hereafter may have against Hanan Palz. By signing my name below, I acknowledge that participation exposes me to a possible risk of personal injury. I am fully aware of this risk and hereby release Hanan Palz from all liability, negligence or other claims arising from or in any way connected with my participation in receiving bodywork. My signature further acknowledges that I shall not now or at any time in the future bring any legal action against Hanan Palz; and that this waiver is binding on me, my heirs, my spouse, my children, my legal representatives, my successors and my assigns.

My signature verifies that I am physically fit to participate and a licensed medical doctor has verified my physical condition for participation in receiving bodywork. If I am pregnant or become pregnant or am post-natal, my signature verifies that I am participating with my doctor’s full approval. I realize that I am participating at my own risk.

My signature is binding to this liability waiver from this day forth.

 

 ______________________________ Signature of Receiver ­­­­­­­­­­­­­­­­­­­­­­­­­­­­­                   ­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­____________ Date

______________________________­­­­­_ Parent or Guardian (if applicable)        

 

Email Address: ______________________________   Phone Number:______________________

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