Massage Service Waiver and Release of Liability Agreement
Client Name:
Date:
PLEASE READ THIS DOCUMENT CAREFULLY BEFORE SIGNING.
This Waiver and Release of Liability Agreement (hereinafter, the “Agreement”) aims to inform the client about the nature of massage services provided by Rafael Galva and to obtain the client’s consent to release Rafael Galva from any liability that may arise from the receipt of such services.
1. Qualification Statement
I, Rafael Galva, declare that I do not hold a state license for the practice of massage therapy. However, I have completed the required study hours and training in the field of massage, which has provided me with the necessary knowledge and skills to offer massage services. My services are offered based on my studies and experience in this discipline.
2. Nature of Services
Massage services provided by Rafael Galva are for general well-being, relaxation, and stress relief purposes. They are not considered medical treatments and are not intended to diagnose, treat, cure, or prevent any disease or medical condition. It is strongly recommended that you consult a licensed healthcare professional for any specific health concerns.
3. Assumption of Risks
I understand and acknowledge that, like any physical activity, massage services carry certain inherent risks, including, but not limited to, minor bruising, temporary discomfort, allergic reactions to products or oils, or the exacerbation of an undisclosed pre-existing condition. I have been informed about the general nature of massages and voluntarily assume all risks associated with receiving these services.
4. Client Responsibility
As a client, I agree to:
- Inform Rafael Galva of any pre-existing medical conditions, injuries, allergies, sensitivities, or medications I am taking, before the massage session begins.
- Communicate any discomfort or pain experienced during the massage session.
- Understand that it is my responsibility to seek professional medical advice for any health concerns.
5. Release and Waiver of Liability
I, the undersigned (the “Client”), for myself, my heirs, executors, administrators, and assigns, hereby forever release, discharge, and acquit Rafael Galva, his agents, employees, and representatives (collectively, the “Released Parties”), from and against any and all claims, demands, actions, causes of action, liabilities, damages, injuries, or expenses of any kind, whether known or unknown, arising from or in connection with the massage services provided by Rafael Galva.
This release includes, but is not limited to, any claim for negligence, whether total or partial, on the part of the Released Parties, to the extent permitted by law.
6. Confidentiality
Rafael Galva commits to maintaining the confidentiality of all information provided by the client.
7. Binding Agreement
I have read this Agreement, fully understood it, and sign it freely and voluntarily, without coercion or undue influence, with full knowledge of its legal meaning. I acknowledge that I have had the opportunity to ask questions and that all my questions have been answered to my full satisfaction.
8. Desired Services
Please check the massage services you are interested in:
9. Areas of Pain or Tension
Please circle or mark the areas of pain or tension on the diagram. Use the legend to indicate intensity.
**M:** Medium
**L:** Mild
Please briefly describe the marked areas and pain intensity (e.g., “Neck: I, Lower back: M”):
Client Signature:
Client Name (Printed):
Date:
Rafael Galva’s Signature:
Rafael Galva’s Name (Printed): Rafael Galva
Date: