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We look forward to welcoming you to The Boca Raton Spa Palmera and Salon at Spa Palmera. Please complete this waiver the day prior, but no later than the morning of your reservation. Please call 561-347-4772 or email spareservations@thebocaraton.com if you have any questions. We are so excited we'll be seeing you soon!

 

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Information
Are you under 21 years old but at least 18 years old?*

If the answer is "YES" to questions 1 or 2 please CEASE completing the release and contact the Spa Concierge at 561-347-4772 immediately to reschedule.

1. In the last 14 days have you experienced or displayed any of the following symptoms: Fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, sore throat, the recent loss of taste or smell, nausea or vomiting, or diarrhea?*
2. In the last 14 days have you had any close contact (within 6 feet) with anyone who is either confirmed or suspected of being infected with COVID-19, including anyone who was experiencing or displaying any of the known symptoms of COVID-19?*

* If the answer to any of these questions changes before the appointment, I agree to notify Spa Palmera as soon as possible. Also, if the answer is yes to any of the previous questions, I understand I will be asked to reschedule the appointment.


Treatment Consent: Despite our careful attention to sterilization, disinfection, and use of personal barriers, there is still a chance that you could be exposed to an illness in our facilities, just as you might be at the grocery store, your gym, or favorite restaurant. "Social Distancing" nationwide has reduced the transmission of COVID-19. Although we have taken measures to provide social distancing in our practice, due to the nature of the services we provide, it is not possible to maintain social distancing between the guests, provider, Spa team and sometimes other guests at all times. Although exposure is unlikely, agreeing to this consent indicates that the risks involved are accepted, and that consent is given for me to be the recipient of the services provided by Spa Palmera - The Boca Raton.*
To preserve the tranquility of the Spa, please speak in low tones and turn your cell phone ringer off. Cell phone conversations are not permitted in Lockers, Ritual Baths, Great Hall or Treatment room. As a convenience, Spa Palmera provides a locker key, robe, and sandals. Please do not remove these items from the spa. The following fees will be applied to items not returned: Robe 150.00, Sandals 55.00, Key 40.00. To ensure the best experience, please share with your provider any health conditions you may have, or recent surgeries/procedures. Lockers are for daily use only. Do not leave any items as they will be removed by Security. The spa is not responsible for lost items. By signing this agreement, I acknowledge that I have read and accept the items above. I waive and relinquish all rights I have now or may have in the future against the Spa and its affiliated companies. I agree to indemnify and hold them harmless from any and all claims for bodily injury, personal injury, property loss or other damages which may arise as a result of my use of the Spa.*
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information
Are you under 21 years old but at least 18 years old?*

If the answer is "YES" to questions 1 or 2 please CEASE completing the release and contact the Spa Concierge at 561-347-4772 immediately to reschedule.

1. In the last 14 days have you experienced or displayed any of the following symptoms: Fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, sore throat, the recent loss of taste or smell, nausea or vomiting, or diarrhea?*
2. In the last 14 days have you had any close contact (within 6 feet) with anyone who is either confirmed or suspected of being infected with COVID-19, including anyone who was experiencing or displaying any of the known symptoms of COVID-19?*

* If the answer to any of these questions changes before the appointment, I agree to notify Spa Palmera as soon as possible. Also, if the answer is yes to any of the previous questions, I understand I will be asked to reschedule the appointment.


Treatment Consent: Despite our careful attention to sterilization, disinfection, and use of personal barriers, there is still a chance that you could be exposed to an illness in our facilities, just as you might be at the grocery store, your gym, or favorite restaurant. "Social Distancing" nationwide has reduced the transmission of COVID-19. Although we have taken measures to provide social distancing in our practice, due to the nature of the services we provide, it is not possible to maintain social distancing between the guests, provider, Spa team and sometimes other guests at all times. Although exposure is unlikely, agreeing to this consent indicates that the risks involved are accepted, and that consent is given for me to be the recipient of the services provided by Spa Palmera - The Boca Raton.*
To preserve the tranquility of the Spa, please speak in low tones and turn your cell phone ringer off. Cell phone conversations are not permitted in Lockers, Ritual Baths, Great Hall or Treatment room. As a convenience, Spa Palmera provides a locker key, robe, and sandals. Please do not remove these items from the spa. The following fees will be applied to items not returned: Robe 150.00, Sandals 55.00, Key 40.00. To ensure the best experience, please share with your provider any health conditions you may have, or recent surgeries/procedures. Lockers are for daily use only. Do not leave any items as they will be removed by Security. The spa is not responsible for lost items. By signing this agreement, I acknowledge that I have read and accept the items above. I waive and relinquish all rights I have now or may have in the future against the Spa and its affiliated companies. I agree to indemnify and hold them harmless from any and all claims for bodily injury, personal injury, property loss or other damages which may arise as a result of my use of the Spa.*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information
Are you under 21 years old but at least 18 years old?*

If the answer is "YES" to questions 1 or 2 please CEASE completing the release and contact the Spa Concierge at 561-347-4772 immediately to reschedule.

1. In the last 14 days have you experienced or displayed any of the following symptoms: Fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, sore throat, the recent loss of taste or smell, nausea or vomiting, or diarrhea?*
2. In the last 14 days have you had any close contact (within 6 feet) with anyone who is either confirmed or suspected of being infected with COVID-19, including anyone who was experiencing or displaying any of the known symptoms of COVID-19?*

* If the answer to any of these questions changes before the appointment, I agree to notify Spa Palmera as soon as possible. Also, if the answer is yes to any of the previous questions, I understand I will be asked to reschedule the appointment.


Treatment Consent: Despite our careful attention to sterilization, disinfection, and use of personal barriers, there is still a chance that you could be exposed to an illness in our facilities, just as you might be at the grocery store, your gym, or favorite restaurant. "Social Distancing" nationwide has reduced the transmission of COVID-19. Although we have taken measures to provide social distancing in our practice, due to the nature of the services we provide, it is not possible to maintain social distancing between the guests, provider, Spa team and sometimes other guests at all times. Although exposure is unlikely, agreeing to this consent indicates that the risks involved are accepted, and that consent is given for me to be the recipient of the services provided by Spa Palmera - The Boca Raton.*
To preserve the tranquility of the Spa, please speak in low tones and turn your cell phone ringer off. Cell phone conversations are not permitted in Lockers, Ritual Baths, Great Hall or Treatment room. As a convenience, Spa Palmera provides a locker key, robe, and sandals. Please do not remove these items from the spa. The following fees will be applied to items not returned: Robe 150.00, Sandals 55.00, Key 40.00. To ensure the best experience, please share with your provider any health conditions you may have, or recent surgeries/procedures. Lockers are for daily use only. Do not leave any items as they will be removed by Security. The spa is not responsible for lost items. By signing this agreement, I acknowledge that I have read and accept the items above. I waive and relinquish all rights I have now or may have in the future against the Spa and its affiliated companies. I agree to indemnify and hold them harmless from any and all claims for bodily injury, personal injury, property loss or other damages which may arise as a result of my use of the Spa.*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information
Are you under 21 years old but at least 18 years old?*

If the answer is "YES" to questions 1 or 2 please CEASE completing the release and contact the Spa Concierge at 561-347-4772 immediately to reschedule.

1. In the last 14 days have you experienced or displayed any of the following symptoms: Fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, sore throat, the recent loss of taste or smell, nausea or vomiting, or diarrhea?*
2. In the last 14 days have you had any close contact (within 6 feet) with anyone who is either confirmed or suspected of being infected with COVID-19, including anyone who was experiencing or displaying any of the known symptoms of COVID-19?*

* If the answer to any of these questions changes before the appointment, I agree to notify Spa Palmera as soon as possible. Also, if the answer is yes to any of the previous questions, I understand I will be asked to reschedule the appointment.


Treatment Consent: Despite our careful attention to sterilization, disinfection, and use of personal barriers, there is still a chance that you could be exposed to an illness in our facilities, just as you might be at the grocery store, your gym, or favorite restaurant. "Social Distancing" nationwide has reduced the transmission of COVID-19. Although we have taken measures to provide social distancing in our practice, due to the nature of the services we provide, it is not possible to maintain social distancing between the guests, provider, Spa team and sometimes other guests at all times. Although exposure is unlikely, agreeing to this consent indicates that the risks involved are accepted, and that consent is given for me to be the recipient of the services provided by Spa Palmera - The Boca Raton.*
To preserve the tranquility of the Spa, please speak in low tones and turn your cell phone ringer off. Cell phone conversations are not permitted in Lockers, Ritual Baths, Great Hall or Treatment room. As a convenience, Spa Palmera provides a locker key, robe, and sandals. Please do not remove these items from the spa. The following fees will be applied to items not returned: Robe 150.00, Sandals 55.00, Key 40.00. To ensure the best experience, please share with your provider any health conditions you may have, or recent surgeries/procedures. Lockers are for daily use only. Do not leave any items as they will be removed by Security. The spa is not responsible for lost items. By signing this agreement, I acknowledge that I have read and accept the items above. I waive and relinquish all rights I have now or may have in the future against the Spa and its affiliated companies. I agree to indemnify and hold them harmless from any and all claims for bodily injury, personal injury, property loss or other damages which may arise as a result of my use of the Spa.*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information
Are you under 21 years old but at least 18 years old?*

If the answer is "YES" to questions 1 or 2 please CEASE completing the release and contact the Spa Concierge at 561-347-4772 immediately to reschedule.

1. In the last 14 days have you experienced or displayed any of the following symptoms: Fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, sore throat, the recent loss of taste or smell, nausea or vomiting, or diarrhea?*
2. In the last 14 days have you had any close contact (within 6 feet) with anyone who is either confirmed or suspected of being infected with COVID-19, including anyone who was experiencing or displaying any of the known symptoms of COVID-19?*

* If the answer to any of these questions changes before the appointment, I agree to notify Spa Palmera as soon as possible. Also, if the answer is yes to any of the previous questions, I understand I will be asked to reschedule the appointment.


Treatment Consent: Despite our careful attention to sterilization, disinfection, and use of personal barriers, there is still a chance that you could be exposed to an illness in our facilities, just as you might be at the grocery store, your gym, or favorite restaurant. "Social Distancing" nationwide has reduced the transmission of COVID-19. Although we have taken measures to provide social distancing in our practice, due to the nature of the services we provide, it is not possible to maintain social distancing between the guests, provider, Spa team and sometimes other guests at all times. Although exposure is unlikely, agreeing to this consent indicates that the risks involved are accepted, and that consent is given for me to be the recipient of the services provided by Spa Palmera - The Boca Raton.*
To preserve the tranquility of the Spa, please speak in low tones and turn your cell phone ringer off. Cell phone conversations are not permitted in Lockers, Ritual Baths, Great Hall or Treatment room. As a convenience, Spa Palmera provides a locker key, robe, and sandals. Please do not remove these items from the spa. The following fees will be applied to items not returned: Robe 150.00, Sandals 55.00, Key 40.00. To ensure the best experience, please share with your provider any health conditions you may have, or recent surgeries/procedures. Lockers are for daily use only. Do not leave any items as they will be removed by Security. The spa is not responsible for lost items. By signing this agreement, I acknowledge that I have read and accept the items above. I waive and relinquish all rights I have now or may have in the future against the Spa and its affiliated companies. I agree to indemnify and hold them harmless from any and all claims for bodily injury, personal injury, property loss or other damages which may arise as a result of my use of the Spa.*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information
Are you under 21 years old but at least 18 years old?*

If the answer is "YES" to questions 1 or 2 please CEASE completing the release and contact the Spa Concierge at 561-347-4772 immediately to reschedule.

1. In the last 14 days have you experienced or displayed any of the following symptoms: Fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, sore throat, the recent loss of taste or smell, nausea or vomiting, or diarrhea?*
2. In the last 14 days have you had any close contact (within 6 feet) with anyone who is either confirmed or suspected of being infected with COVID-19, including anyone who was experiencing or displaying any of the known symptoms of COVID-19?*

* If the answer to any of these questions changes before the appointment, I agree to notify Spa Palmera as soon as possible. Also, if the answer is yes to any of the previous questions, I understand I will be asked to reschedule the appointment.


Treatment Consent: Despite our careful attention to sterilization, disinfection, and use of personal barriers, there is still a chance that you could be exposed to an illness in our facilities, just as you might be at the grocery store, your gym, or favorite restaurant. "Social Distancing" nationwide has reduced the transmission of COVID-19. Although we have taken measures to provide social distancing in our practice, due to the nature of the services we provide, it is not possible to maintain social distancing between the guests, provider, Spa team and sometimes other guests at all times. Although exposure is unlikely, agreeing to this consent indicates that the risks involved are accepted, and that consent is given for me to be the recipient of the services provided by Spa Palmera - The Boca Raton.*
To preserve the tranquility of the Spa, please speak in low tones and turn your cell phone ringer off. Cell phone conversations are not permitted in Lockers, Ritual Baths, Great Hall or Treatment room. As a convenience, Spa Palmera provides a locker key, robe, and sandals. Please do not remove these items from the spa. The following fees will be applied to items not returned: Robe 150.00, Sandals 55.00, Key 40.00. To ensure the best experience, please share with your provider any health conditions you may have, or recent surgeries/procedures. Lockers are for daily use only. Do not leave any items as they will be removed by Security. The spa is not responsible for lost items. By signing this agreement, I acknowledge that I have read and accept the items above. I waive and relinquish all rights I have now or may have in the future against the Spa and its affiliated companies. I agree to indemnify and hold them harmless from any and all claims for bodily injury, personal injury, property loss or other damages which may arise as a result of my use of the Spa.*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information
Are you under 21 years old but at least 18 years old?*

If the answer is "YES" to questions 1 or 2 please CEASE completing the release and contact the Spa Concierge at 561-347-4772 immediately to reschedule.

1. In the last 14 days have you experienced or displayed any of the following symptoms: Fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, sore throat, the recent loss of taste or smell, nausea or vomiting, or diarrhea?*
2. In the last 14 days have you had any close contact (within 6 feet) with anyone who is either confirmed or suspected of being infected with COVID-19, including anyone who was experiencing or displaying any of the known symptoms of COVID-19?*

* If the answer to any of these questions changes before the appointment, I agree to notify Spa Palmera as soon as possible. Also, if the answer is yes to any of the previous questions, I understand I will be asked to reschedule the appointment.


Treatment Consent: Despite our careful attention to sterilization, disinfection, and use of personal barriers, there is still a chance that you could be exposed to an illness in our facilities, just as you might be at the grocery store, your gym, or favorite restaurant. "Social Distancing" nationwide has reduced the transmission of COVID-19. Although we have taken measures to provide social distancing in our practice, due to the nature of the services we provide, it is not possible to maintain social distancing between the guests, provider, Spa team and sometimes other guests at all times. Although exposure is unlikely, agreeing to this consent indicates that the risks involved are accepted, and that consent is given for me to be the recipient of the services provided by Spa Palmera - The Boca Raton.*
To preserve the tranquility of the Spa, please speak in low tones and turn your cell phone ringer off. Cell phone conversations are not permitted in Lockers, Ritual Baths, Great Hall or Treatment room. As a convenience, Spa Palmera provides a locker key, robe, and sandals. Please do not remove these items from the spa. The following fees will be applied to items not returned: Robe 150.00, Sandals 55.00, Key 40.00. To ensure the best experience, please share with your provider any health conditions you may have, or recent surgeries/procedures. Lockers are for daily use only. Do not leave any items as they will be removed by Security. The spa is not responsible for lost items. By signing this agreement, I acknowledge that I have read and accept the items above. I waive and relinquish all rights I have now or may have in the future against the Spa and its affiliated companies. I agree to indemnify and hold them harmless from any and all claims for bodily injury, personal injury, property loss or other damages which may arise as a result of my use of the Spa.*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information
Are you under 21 years old but at least 18 years old?*

If the answer is "YES" to questions 1 or 2 please CEASE completing the release and contact the Spa Concierge at 561-347-4772 immediately to reschedule.

1. In the last 14 days have you experienced or displayed any of the following symptoms: Fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, sore throat, the recent loss of taste or smell, nausea or vomiting, or diarrhea?*
2. In the last 14 days have you had any close contact (within 6 feet) with anyone who is either confirmed or suspected of being infected with COVID-19, including anyone who was experiencing or displaying any of the known symptoms of COVID-19?*

* If the answer to any of these questions changes before the appointment, I agree to notify Spa Palmera as soon as possible. Also, if the answer is yes to any of the previous questions, I understand I will be asked to reschedule the appointment.


Treatment Consent: Despite our careful attention to sterilization, disinfection, and use of personal barriers, there is still a chance that you could be exposed to an illness in our facilities, just as you might be at the grocery store, your gym, or favorite restaurant. "Social Distancing" nationwide has reduced the transmission of COVID-19. Although we have taken measures to provide social distancing in our practice, due to the nature of the services we provide, it is not possible to maintain social distancing between the guests, provider, Spa team and sometimes other guests at all times. Although exposure is unlikely, agreeing to this consent indicates that the risks involved are accepted, and that consent is given for me to be the recipient of the services provided by Spa Palmera - The Boca Raton.*
To preserve the tranquility of the Spa, please speak in low tones and turn your cell phone ringer off. Cell phone conversations are not permitted in Lockers, Ritual Baths, Great Hall or Treatment room. As a convenience, Spa Palmera provides a locker key, robe, and sandals. Please do not remove these items from the spa. The following fees will be applied to items not returned: Robe 150.00, Sandals 55.00, Key 40.00. To ensure the best experience, please share with your provider any health conditions you may have, or recent surgeries/procedures. Lockers are for daily use only. Do not leave any items as they will be removed by Security. The spa is not responsible for lost items. By signing this agreement, I acknowledge that I have read and accept the items above. I waive and relinquish all rights I have now or may have in the future against the Spa and its affiliated companies. I agree to indemnify and hold them harmless from any and all claims for bodily injury, personal injury, property loss or other damages which may arise as a result of my use of the Spa.*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information
Are you under 21 years old but at least 18 years old?*

If the answer is "YES" to questions 1 or 2 please CEASE completing the release and contact the Spa Concierge at 561-347-4772 immediately to reschedule.

1. In the last 14 days have you experienced or displayed any of the following symptoms: Fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, sore throat, the recent loss of taste or smell, nausea or vomiting, or diarrhea?*
2. In the last 14 days have you had any close contact (within 6 feet) with anyone who is either confirmed or suspected of being infected with COVID-19, including anyone who was experiencing or displaying any of the known symptoms of COVID-19?*

* If the answer to any of these questions changes before the appointment, I agree to notify Spa Palmera as soon as possible. Also, if the answer is yes to any of the previous questions, I understand I will be asked to reschedule the appointment.


Treatment Consent: Despite our careful attention to sterilization, disinfection, and use of personal barriers, there is still a chance that you could be exposed to an illness in our facilities, just as you might be at the grocery store, your gym, or favorite restaurant. "Social Distancing" nationwide has reduced the transmission of COVID-19. Although we have taken measures to provide social distancing in our practice, due to the nature of the services we provide, it is not possible to maintain social distancing between the guests, provider, Spa team and sometimes other guests at all times. Although exposure is unlikely, agreeing to this consent indicates that the risks involved are accepted, and that consent is given for me to be the recipient of the services provided by Spa Palmera - The Boca Raton.*
To preserve the tranquility of the Spa, please speak in low tones and turn your cell phone ringer off. Cell phone conversations are not permitted in Lockers, Ritual Baths, Great Hall or Treatment room. As a convenience, Spa Palmera provides a locker key, robe, and sandals. Please do not remove these items from the spa. The following fees will be applied to items not returned: Robe 150.00, Sandals 55.00, Key 40.00. To ensure the best experience, please share with your provider any health conditions you may have, or recent surgeries/procedures. Lockers are for daily use only. Do not leave any items as they will be removed by Security. The spa is not responsible for lost items. By signing this agreement, I acknowledge that I have read and accept the items above. I waive and relinquish all rights I have now or may have in the future against the Spa and its affiliated companies. I agree to indemnify and hold them harmless from any and all claims for bodily injury, personal injury, property loss or other damages which may arise as a result of my use of the Spa.*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information
Are you under 21 years old but at least 18 years old?*

If the answer is "YES" to questions 1 or 2 please CEASE completing the release and contact the Spa Concierge at 561-347-4772 immediately to reschedule.

1. In the last 14 days have you experienced or displayed any of the following symptoms: Fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, sore throat, the recent loss of taste or smell, nausea or vomiting, or diarrhea?*
2. In the last 14 days have you had any close contact (within 6 feet) with anyone who is either confirmed or suspected of being infected with COVID-19, including anyone who was experiencing or displaying any of the known symptoms of COVID-19?*

* If the answer to any of these questions changes before the appointment, I agree to notify Spa Palmera as soon as possible. Also, if the answer is yes to any of the previous questions, I understand I will be asked to reschedule the appointment.


Treatment Consent: Despite our careful attention to sterilization, disinfection, and use of personal barriers, there is still a chance that you could be exposed to an illness in our facilities, just as you might be at the grocery store, your gym, or favorite restaurant. "Social Distancing" nationwide has reduced the transmission of COVID-19. Although we have taken measures to provide social distancing in our practice, due to the nature of the services we provide, it is not possible to maintain social distancing between the guests, provider, Spa team and sometimes other guests at all times. Although exposure is unlikely, agreeing to this consent indicates that the risks involved are accepted, and that consent is given for me to be the recipient of the services provided by Spa Palmera - The Boca Raton.*
To preserve the tranquility of the Spa, please speak in low tones and turn your cell phone ringer off. Cell phone conversations are not permitted in Lockers, Ritual Baths, Great Hall or Treatment room. As a convenience, Spa Palmera provides a locker key, robe, and sandals. Please do not remove these items from the spa. The following fees will be applied to items not returned: Robe 150.00, Sandals 55.00, Key 40.00. To ensure the best experience, please share with your provider any health conditions you may have, or recent surgeries/procedures. Lockers are for daily use only. Do not leave any items as they will be removed by Security. The spa is not responsible for lost items. By signing this agreement, I acknowledge that I have read and accept the items above. I waive and relinquish all rights I have now or may have in the future against the Spa and its affiliated companies. I agree to indemnify and hold them harmless from any and all claims for bodily injury, personal injury, property loss or other damages which may arise as a result of my use of the Spa.*
Parent or Guardian's Email Address

Email
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information
Are you under 21 years old but at least 18 years old?*

If the answer is "YES" to questions 1 or 2 please CEASE completing the release and contact the Spa Concierge at 561-347-4772 immediately to reschedule.

1. In the last 14 days have you experienced or displayed any of the following symptoms: Fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, sore throat, the recent loss of taste or smell, nausea or vomiting, or diarrhea?*
2. In the last 14 days have you had any close contact (within 6 feet) with anyone who is either confirmed or suspected of being infected with COVID-19, including anyone who was experiencing or displaying any of the known symptoms of COVID-19?*

* If the answer to any of these questions changes before the appointment, I agree to notify Spa Palmera as soon as possible. Also, if the answer is yes to any of the previous questions, I understand I will be asked to reschedule the appointment.


Treatment Consent: Despite our careful attention to sterilization, disinfection, and use of personal barriers, there is still a chance that you could be exposed to an illness in our facilities, just as you might be at the grocery store, your gym, or favorite restaurant. "Social Distancing" nationwide has reduced the transmission of COVID-19. Although we have taken measures to provide social distancing in our practice, due to the nature of the services we provide, it is not possible to maintain social distancing between the guests, provider, Spa team and sometimes other guests at all times. Although exposure is unlikely, agreeing to this consent indicates that the risks involved are accepted, and that consent is given for me to be the recipient of the services provided by Spa Palmera - The Boca Raton.*
To preserve the tranquility of the Spa, please speak in low tones and turn your cell phone ringer off. Cell phone conversations are not permitted in Lockers, Ritual Baths, Great Hall or Treatment room. As a convenience, Spa Palmera provides a locker key, robe, and sandals. Please do not remove these items from the spa. The following fees will be applied to items not returned: Robe 150.00, Sandals 55.00, Key 40.00. To ensure the best experience, please share with your provider any health conditions you may have, or recent surgeries/procedures. Lockers are for daily use only. Do not leave any items as they will be removed by Security. The spa is not responsible for lost items. By signing this agreement, I acknowledge that I have read and accept the items above. I waive and relinquish all rights I have now or may have in the future against the Spa and its affiliated companies. I agree to indemnify and hold them harmless from any and all claims for bodily injury, personal injury, property loss or other damages which may arise as a result of my use of the Spa.*
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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