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RISE BODYWORKS

MASSAGE/ART MASSAGE THERAPY AGREEMENT PACKAGE

WAIVERS & AGREEMENTS

Read entire waiver thoroughly before agreeing and signing
RISE Bodyworks - 1226 Park St, Alameda CA 94501

WAIVERS AND COVID 19, AUTOPAY, and TERMS & AGREEMENTS

MASSAGE/ART MASSAGE & GENERAL WAIVER

I have met with and received an instructional consultation about massage therapy and do hereby understand and acknowledge that receiving massage therapy may expose me to inherent risks, including but not limited to accidents, injury, or even death. I assume all risks associated with participation in this activity at RISE Bodyworks.

I Agree

I hereby acknowledge my responsibility in communicating any physical and psychological concerns that might conflict with participation in such activity. I acknowledge that I am physically able and mentally capable of receiving massage therapy at RISE Bodyworks.

I Agree

After having read this waiver in its entirety and understanding these facts, and in consideration of acceptance of my participation and Rise Bodyworks furnishing its services to me. I agree that I, and anyone else entitled to act on my behalf, will hold harmless, waive, and release RISE Bodyworks, its employees, representatives, etc. from any responsibility, liabilities, demands, or claims of any kind arising out of my participation in receiving massage therapy.

I Agree

I understand that these injuries or outcomes may arise from my own or others' negligence, conditions related to travel, or the condition of the location(s). Nonetheless, I assume all related risks, both known or unknown to me, of my participation in this Activity, including travel to, from and during this Care. I hereby release RISE Bodyworks and their directors, affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns.

I Agree

I agree to indemnify and hold harmless RISE Bodyworks against any and all claims suits or actions of any kind whatsoever for liability, damages, compensation or otherwise caused by me or anyone on my behalf, including attorney's fees and any related costs, if litigation arises pursuant to any claims made by or against me or by or against anyone else acting on my behalf. If RISE Bodyworks incurs any of these types of expenses, I agree to reimburse RISE Bodyworks.

I Agree

COVID 19 WAIVER 

RISE Bodyworks is open for use by other individuals, I recognize that I am at higher risk of contracting COVID-19. With full awareness and appreciation of the risks involved, I, for myself and on behalf of my family, spouse, estate, heroes, executors, administrators, assigns, and personal representatives, hereby forever release, waive, discharge, and covenant not to sue RISE BODYWORKS, its’ staff, owners, constituents and contractors, from any and all liability, claims, demands, actions, and causes of action whatsoever, directly or indirectly arising out of or related to any loss, damage, or injury, including death, that may be sustained by me related to COVID-19 whether caused by the negligence of the Released Parties, any third-party using RISE facilities or otherwise, while participating in any activity while in, on or around the RISE facilities, tools, equipment, machines, or materials. I VOLUNTARY AGREE IT IS MY INTENTION TO EXEMPT AND RELIEVE RISE BODYWORKS, its’ staff, owners, constituents and contractors, FROM LIABILITY FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH CAUSED BY NEGLIGENCE OR ANY OTHER CAUSE. I agree to comply with all RISE BODYWORKS policies and rules, including but not limited to all RISE BODYWORKS guidelines, recommendations for safety, signage and instructions related to COVID 19 mandates and precautions. I agree that I am personally responsible for my safety and actions while using the facilities at RISE BODYWORKS.

I Agree

Masks must be properly worn at all times in unvaccinated. Proof of full vaccination, e.g. vaccination card, must be provided one time to the front desk. You must agree to socially distance between yourself and other members, minimally 6 ft apart.

I Agree

You are not allowed in the building if you have any COVID symptoms.

I Agree

FACILITY USE POLICY (AGREEMENT)

All members using the RISE Bodyworks, Wellness Center Clinic will only be able to do so once they have a valid account in our MindBody system, have signed and authorized all terms/agreements and waivers

I Agree

Clinic patients must pre-register for their appointments using our online system.

I Agree

Wash your hands/use hand sanitizer upon entry of building and before clinic appointment. Wash your hands/use hand sanitizer after class and when leaving the building

I Agree

Adhere to ALL new and existing signage throughout the building and on the front door of RISE Bodyworks

I Agree

Adhere to all RISE staff requests & instructions verbally provided to you. It’s not acceptable to disregard instructions given to you by any staff person. Hostile behavior towards the staff will result in permanent membership cancellation

I Agree

Failure to comply with any RISE Bodyworks policy, request or instructions will be asked to leave the building and/or membership cancelled. RISE Bodyworks is required to follow all mandates from Alameda County and the State of California, and implements these requirements for the health of and safety of our members, patients, and our staff

I Agree

TERMS AND AGREEMENTS

Payments and/or Memberships: Non-Membership Payment is due at the time service provided. If your insurance denies payment you agree to pay the full cash amount due to RISE Bodyworks.  If you have a recurring Custom Membership or Massage Membership, you understand that each month's Massage/ART Massage service, when part of the discounted membership, EXPIRES 30-DAYS after the auto-payment date. Unused Massage appointments in any given month DO NOT ROLLOVER to the next month and are NOT TRANSFERABLE. NO EXCEPTIONS

I Agree

Communication: You are required to maintain an active email address on record with RiSE Bodyworks to ensure open communication regarding, but not limited to, emergencies, forces of nature, our schedule, operations and/or crucial updates. Additionally, you agree to assign risebodyworks@gmail.com as an approved contact and stay subscribed to our emails for as long as you are a member. Rise Bodyworks will communicate with you via email and social media to ensure crucial updates are disseminated and received by our valued members, patients and clients. In the event of a national, global emergency/disaster we must have your current contact information.

I Agree

Building Etiquette: You agree to abide by the building rules and posted signs, staff/trainer instruction, county orders and accept that you may be asked to vacate the building or that your membership may be revoked if you fail to comply.

I Agree

Appointments and Massage Memberships: Appointments- Clinic Service appointments, e.g. Chiropractic, Massage, ART Massage, One-On-One Training, etc, can be made online through our online booking system. To make an appointment you must have an active account in our booking system with a valid Credit Card on file. Cancellations of less than 24 hours will be considered a LATE CANCEL and you will be charged for the missed appointment. Cancel your appointments online or by emailing us at risebodyworks@gmail.com. 

I Agree

Refunds: You understand there are NO partial or full refunds, or account credits. All sales are final.

I Agree

If you have any questions, email us at risebodyworks@gmail.com

I Agree

The undersigned understands and agrees to the above stipulations, terms and agreements:

Dated: June 28, 2022

 


First Client’s Name

First Name*

Last Name*

Phone*
First Client’s Date of Birth*
I certify that I am 18 years of age or older
First Client’s Signature*
Second Client’s Name

First Name*

Last Name*
Second Client’s Date of Birth*
Third Client’s Name

First Name*

Last Name*
Third Client’s Date of Birth*
Fourth Client’s Name

First Name*

Last Name*
Fourth Client’s Date of Birth*
Fifth Client’s Name

First Name*

Last Name*
Fifth Client’s Date of Birth*
Sixth Client’s Name

First Name*

Last Name*
Sixth Client’s Date of Birth*
Seventh Client’s Name

First Name*

Last Name*
Seventh Client’s Date of Birth*
Eighth Client’s Name

First Name*

Last Name*
Eighth Client’s Date of Birth*
Ninth Client’s Name

First Name*

Last Name*
Ninth Client’s Date of Birth*
Tenth Client’s Name

First Name*

Last Name*
Tenth Client’s Date of Birth*
Client’s Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
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.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
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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