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Liability Waiver
First Name
Last Name
Email
Date of Birth
Do you have a health consition that would limit you from recieving in intense physical massage?
No
Yes
Phone
Please specify anything we should know about
Initials
I declare that the info I’ve provided is accurate & complete
I hereby acknowledge this release from liability for accidental injury or illness which I may incur as a result of recieving this deep tissue massage. I hereby assume all risks connected therewith and consent to participate in this service. I agree to disclose my physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in this massage.
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