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FLOATATION WAIVER




FLOATATION THERAPY SESSIONS

 

I agree to NOT use the float pod under any of the following circumstances:

 

- If I have not showered thoroughly with the provided "pre-float" body wash provided by our spa to remove any creams, oils, or makeup

- If I have had any type of hair color/treatment within the past two weeks or have any hair color that would bleed into the water or onto a white towel

- If I am under the Influence of drugs or alcohol

- If I have a communicable or Infectious skin condition, disorder, or disease

- If I have open sores

- If I am diabetic, unless my diabetes Is under medical control

- If I have a history of heart trouble, epilepsy, seizures, or blackouts, and have not received my doctors (written) permission to use the float pod

- If I am menstruating or experiencing some other sort of external vaginal Issues

- If I have a condition which may be adversely affected by cutaneous absorption of magnesium

- If I have kidney disease and have not received my doctor's (written) permission to use the float pod

- If I may release bodily fluids, voluntarily or involuntarily, Into the float pod

Please note: Our staff Is not trained in assisted transfers. If you need assistance getting In or out of the float pod, it is best for you to bring your own helper.

 

>> I have read and understand all the terms listed above. I understand that violation of any of these rules that result in contamination of the float pod water may result in a

cleaning and salt replacement fee of up to $1000.



 

CANCELLATION POLICY

 

 I agree to the 48 hour cancellation policy. If I am a No-Show or last minute cancellation, I agree to pay for my service in full. If a gift certificate was used to reserve my spot, the voucher will be redeemed. Cancellation must be by phone or email at least 48 hours before my service. I understand my service starts at the designated appointment time and if I am late, my service will be shortened to not affect the next person after me.



First Client Name

First Name*

Last Name*

Phone*
First Client Date of Birth*
First Client Information
I agree to pay for my full float session even if I exit before the full time. Anything after 10 minutes is considered a full session. We will not discount your fee unless you come out the first 10 minutes.*
Yes
Do you have a Gift card or Gift certificate?*
No
Yes

If yes, how much is the gift amount? *
Are you currently pregnant?*
No
Yes

If yes, how far along?

Any high risk factors?
First Client Signature*
Second Client Name

First Name*

Last Name*
Second Client Date of Birth*
Second Client Information
I agree to pay for my full float session even if I exit before the full time. Anything after 10 minutes is considered a full session. We will not discount your fee unless you come out the first 10 minutes.*
Yes
Do you have a Gift card or Gift certificate?*
No
Yes

If yes, how much is the gift amount? *
Are you currently pregnant?*
No
Yes

If yes, how far along?

Any high risk factors?
Third Client Name

First Name*

Last Name*
Third Client Date of Birth*
Third Client Information
I agree to pay for my full float session even if I exit before the full time. Anything after 10 minutes is considered a full session. We will not discount your fee unless you come out the first 10 minutes.*
Yes
Do you have a Gift card or Gift certificate?*
No
Yes

If yes, how much is the gift amount? *
Are you currently pregnant?*
No
Yes

If yes, how far along?

Any high risk factors?
Fourth Client Name

First Name*

Last Name*
Fourth Client Date of Birth*
Fourth Client Information
I agree to pay for my full float session even if I exit before the full time. Anything after 10 minutes is considered a full session. We will not discount your fee unless you come out the first 10 minutes.*
Yes
Do you have a Gift card or Gift certificate?*
No
Yes

If yes, how much is the gift amount? *
Are you currently pregnant?*
No
Yes

If yes, how far along?

Any high risk factors?
Fifth Client Name

First Name*

Last Name*
Fifth Client Date of Birth*
Fifth Client Information
I agree to pay for my full float session even if I exit before the full time. Anything after 10 minutes is considered a full session. We will not discount your fee unless you come out the first 10 minutes.*
Yes
Do you have a Gift card or Gift certificate?*
No
Yes

If yes, how much is the gift amount? *
Are you currently pregnant?*
No
Yes

If yes, how far along?

Any high risk factors?
Sixth Client Name

First Name*

Last Name*
Sixth Client Date of Birth*
Sixth Client Information
I agree to pay for my full float session even if I exit before the full time. Anything after 10 minutes is considered a full session. We will not discount your fee unless you come out the first 10 minutes.*
Yes
Do you have a Gift card or Gift certificate?*
No
Yes

If yes, how much is the gift amount? *
Are you currently pregnant?*
No
Yes

If yes, how far along?

Any high risk factors?
Seventh Client Name

First Name*

Last Name*
Seventh Client Date of Birth*
Seventh Client Information
I agree to pay for my full float session even if I exit before the full time. Anything after 10 minutes is considered a full session. We will not discount your fee unless you come out the first 10 minutes.*
Yes
Do you have a Gift card or Gift certificate?*
No
Yes

If yes, how much is the gift amount? *
Are you currently pregnant?*
No
Yes

If yes, how far along?

Any high risk factors?
Eighth Client Name

First Name*

Last Name*
Eighth Client Date of Birth*
Eighth Client Information
I agree to pay for my full float session even if I exit before the full time. Anything after 10 minutes is considered a full session. We will not discount your fee unless you come out the first 10 minutes.*
Yes
Do you have a Gift card or Gift certificate?*
No
Yes

If yes, how much is the gift amount? *
Are you currently pregnant?*
No
Yes

If yes, how far along?

Any high risk factors?
Ninth Client Name

First Name*

Last Name*
Ninth Client Date of Birth*
Ninth Client Information
I agree to pay for my full float session even if I exit before the full time. Anything after 10 minutes is considered a full session. We will not discount your fee unless you come out the first 10 minutes.*
Yes
Do you have a Gift card or Gift certificate?*
No
Yes

If yes, how much is the gift amount? *
Are you currently pregnant?*
No
Yes

If yes, how far along?

Any high risk factors?
Tenth Client Name

First Name*

Last Name*
Tenth Client Date of Birth*
Tenth Client Information
I agree to pay for my full float session even if I exit before the full time. Anything after 10 minutes is considered a full session. We will not discount your fee unless you come out the first 10 minutes.*
Yes
Do you have a Gift card or Gift certificate?*
No
Yes

If yes, how much is the gift amount? *
Are you currently pregnant?*
No
Yes

If yes, how far along?

Any high risk factors?
Parent or Guardian's Email Address

Email*

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

First Name*

Last 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.


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 Date of Birth*
Parent or Guardian's Information
I agree to pay for my full float session even if I exit before the full time. Anything after 10 minutes is considered a full session. We will not discount your fee unless you come out the first 10 minutes.*
Yes
Do you have a Gift card or Gift certificate?*
No
Yes

If yes, how much is the gift amount? *
Are you currently pregnant?*
No
Yes

If yes, how far along?

Any high risk factors?
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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