By signing this waiver, I agree to the above terms and conditions.

Name

First Name

Last Name

Waver Questionnaire

I understand that massage therapy is provided for the purposes of stress reduction, relaxation, relief from muscular tension, and improvement of circulation and energy flow.

I will immediately inform my therapist if I experience any pain or discomfort during the session so pressure or techniques can be adjusted to my comfort level. I agree not to hold my therapist responsible for any discomfort experienced during or after the session.

I understand that massage therapy is not a substitute for medical care, and that my therapist is not qualified to diagnose, prescribe, treat, or perform spinal/skeletal adjustments.

I confirm that I have disclosed all known medical conditions, injuries, and physical limitations to my therapist.

I agree to notify my therapist of any changes in my health status in the future. I understand my therapist is not liable if I fail to share relevant health updates.

I understand that massage therapy at TC5 Kinetic Therapy is entirely therapeutic and non-sexual in nature.

I hereby waive, release, and discharge my therapist and TC5 Kinetic Therapy from any and all liability, past, present, and future, in connection with any massage or bodywork session I receive.

I am under the age of 18 and understand that my parent or legal guardian must provide written consent for me to receive massage therapy services. I will have my legal guardian sign this form on my behalf.

I am the parent or legal guardian of the minor receiving massage therapy. I give my informed consent for treatment and agree to the terms outlined above.

I have received, read, and agree to the TC5 Kinetic Therapy Policy Statement.

As the parent or legal guardian, do you give permission for photos, videos, or other recordings of your child to be taken during this session, and for these materials to be used on our website, social media platforms or other promotional materials.

You understand and agree that all services rendered are non-refundable, regardless of outcome or satisfaction.