Chair Massage Release Form printable pdf download

Chair Massage Release Form

By signing below you acknowledge that you have scheduled one or more chair massage(s) from Carrie

Mahoney with Body Logic Massage & Yoga. You understand that massage should not be performed under

certain medical conditions and consent that to the best of your knowledge you are physically and mentally

healthy enough to receive massage. All sessions are completely non-sexual and every effort will be made

to "Do No Harm" to you. However, you understand that it is your sole responsibility to inform the massage

therapist if you experience any pain or discomfort during the session. You also agree to accept full

responsibility for your body and actions and agree to release and indemnify Carrie Mahoney, Body Logic

Massage & Yoga, Berea College or any of its trustees, officers or staff from any and all claims or injuries

relating to this or any future massage session. Carrie Mahoney and Body Logic Massage & Yoga are

independent contractors and not associated with Berea College. This service is being provided on-site at

the college as an accommodation to you.

Check Applicable Box:

____ I have no physical, mental or other conditions precluding massage therapy.

_____ I have the following physical, mental or other conditions that may affect receiving massage therapy

(list all):

_____________________________________________________________________________________

Printed name: _____________________________________________

Signature:_________________________________________________ Date: ___________________

Chair Massage Release Form