g u e s t p r o f i l e f o r b o d y + m a s s a g e s e r v i c e s
Name:
Minor Name: <CHILDFIRSTNAME> <CHILDLASTNAME>
Minor Name: <CHILDFIRSTNAME> <CHILDLASTNAME>
Minor Name: <CHILDFIRSTNAME> <CHILDLASTNAME>
Minor Name: <CHILDFIRSTNAME> <CHILDLASTNAME>
Minor Name: <CHILDFIRSTNAME> <CHILDLASTNAME>
Minor Name: <CHILDFIRSTNAME> <CHILDLASTNAME>
Minor Name: <CHILDFIRSTNAME> <CHILDLASTNAME>
Minor Name: <CHILDFIRSTNAME> <CHILDLASTNAME>
Minor Name: <CHILDFIRSTNAME> <CHILDLASTNAME>
Minor Name: <CHILDFIRSTNAME> <CHILDLASTNAME>
Is there someone we should thank for your referral?
ARE YOU CURRENTLY AFFECTED BY ANY OF THESE CONDITIONS?
If pregnant, how many weeks?
If pregnant, have you experienced any complications, past or current?
Have you ever undergone surgery?
Yes No
If yes, please explain:
Are you currently under the care of a health professional for injuries/medical treatment?
Yes No
If yes, please explain:
Are you currently taking any medication?
Yes No
If yes, please list:
Do you exercise regularly?
Yes No
Do you have difficulty lying on your back, front, or turning on your side?
How often do you receive professional massage?
Is there any area of the body that you do not wish to be massaged during the session?
Yes No
If yes, please list:
Is there a specific part of the body that you would like your massage therapist to focus on in your service?
Yes No
If yes, please list:
i m p o r t a n t n o t e f o r f e m a l e g u e s t s
Hiatus Spa + Retreat’s Standard Operating Procedure states that no therapist may engage in breast massage of female guests, and that draping techniques will be used throughout the entire session to ensure guest privacy and comfort. Hiatus Spa + Retreat and its employees reserve the right to refrain from providing a massage service until written permission is given by your medical professional.
s p a p o l i c i e s, p l e a s e r e a d:
I understand that my visits to Hiatus Spa + Retreat are for the purpose of relaxation, stress reduction, skin and body maintenance or other. To ensure an enjoyable experience, we request that you inform your service provider of any pre-existing conditions, limitations, or specific sensitivities prior to your service. Please understand that it is vital to your experience at Hiatus Spa + Retreat to inform your service provider if you feel any discomfort during the session. You may request that the service provider adjust the level of pressure at any time.
I understand and voluntarily accept any risks associated with my treatment or any use of the spa’s facilities. I agree that Hiatus Spa + Retreat will not be liable for any injury including, without limitation, personal, bodily, or mental injury, economic loss, or any damage to myself resulting from negligence, other acts of the spa, anyone on the spa’s behalf, or anyone using the services of the spa.
In an effort to maintain a large schedule and accommodate every individual guest, we ask that you arrive at least 15 minutes prior to your service start time. An early arrival will ensure ample time to check in, change into spa attire and begin your relaxation.
Initial: Late arrivals are subject to a shortened service time so we may accommodate all guests at their designated appointment time.
Initial: A late cancellation fee equal to 50% of service(s) will be charged if an appointment is cancelled within 24 hours of its arrival time.
Initial: Any missed appointments will be charged in full.
Please note that any personal belongings left on premise are not the responsibility of Hiatus Spa + Retreat. By signing this document, you agree that Hiatus Spa + Retreat will not be held liable for any claims related to loss, theft or damage.
Finally, as a member or guest of Hiatus Spa + Retreat, I agree to alert the massage therapist and subsequently update this document during any future sessions if there have been any notable changes to my condition, or reasons for seeking massage, including injuries, illness, or general preferences.
Any information provided to me by the massage therapist is for educational purposes only and is not intended for any medical or therapeutic purpose. As a guest in this spa, I am aware that if I am uncomfortable for any reason, at any point during the massage, I may ask the therapist to cease the massage and the therapist will then immediately end the session.
Massage therapy is not a substitute for medical examination or diagnosis. It is recommended that I see a physician for any physical ailment that I may have. I understand that the massage therapist does not prescribe medical treatments or pharmaceuticals and does not perform any spinal adjustments. I am aware that if I have any serious medical diagnosis, I must provide a physician’s written consent prior to services.
The licensee shall drape the breasts of all female clients and not engage in breast massage of female clients unless the client gives written consent before each session involving breast massage.
Draping of the genital area and gluteal cleavage will be used at all times during the session for all clients.
If the client is uncomfortable for any reason, the client may ask the licensee to end the massage, and the licensee will end the session. The licensee also has a right to end the session if uncomfortable for any reason.
a n o t e o n g r a t u i t i e s
We take great care to find highly qualified and talented service providers; we are committed to providing you the best possible spa experience. If you feel your experience was exceptional, we kindly ask that your gratuities reflect these industry-standard guidelines on services:
60 minutes + $17 - $25 | 90 minutes + $21 - $35 | 120 minutes + $28 - $46
d i g i t a l d e t o x
To ensure relaxation for all, please turn off your cell phones, iPads, and other electronic devices while in the spa.
Massage Therapist:
Date:
CONSENT, INDEMNITY AND RELEASE/WAIVER
The undersigned, (“Undersigned”), parent/guardian of <CHILDFIRSTNAME> <CHILDLASTNAME> [minor’s name] (“Minor”) hereby consents to Minor’s receipt of spa services and releases from all liability all “Hiatus Spa + Retreat” entities, which include Hiatus LLC, Hiatus Austin LLC, Hiatus Plano LLC, Hiatus San Antonio LLC, Hiatus Houston LLC, Hiatus Fort Worth LLC, Hiatus Dallas 2 LLC, or Hiatus Frisco LLC (collectively “Hiatus”), related to Minor’s receipt of spa services from Hiatus.
1. Consent.
By submitting this Consent, Indemnity and Release/Waiver on Minor’s behalf, I am representing to Hiatus that both Minor and Undersigned, as Minor’s parent or guardian, consent to Hiatus rendering spa services to Minor in accordance with the Texas Administrative Code, Title 25, Part 1, Chapter 140, Subchapter H, Division 2, Rule 140.303, Letter F, which states, “A licensee must obtain the written consent of a parent or guardian to provide massage therapy services to a person under the age of 17.”
I understand Minor will be receiving a spa service from a circle one: male / female service provider and give my consent. I also acknowledge that, as Minor’s parent or guardian, I am required to be in the treatment room with Minor during any massage services.
Spa services include, but are not limited to, massage, nail therapy and facials. Further, I understand that Hiatus is relying upon this Consent, Indemnity and Release/Waiver and would not, without it, proceed to render spa services to Minor.
2. Indemnity.
Undersigned shall indemnify and hold harmless Hiatus and its respective owners, members, officers, agents, and employees against any claim, loss, damage, expense or liability resulting from or arising out of Hiatus’ rendering of spa services to Minor.
3. Release/Waiver.
Undersigned agrees that Hiatus and its respective owners, members, officers, agents, and employees shall not be liable to the undersigned, Minor or anyone purporting to act on behalf of Minor, for any injury to person or damage to property sustained by Minor or any person claiming through Minor resulting from any accident or occurrence in the course of Minor’s receipt of spa services from Hiatus.
In witness whereof, the parties have entered into this Consent, Indemnity and Release/Waiver as of this date, , [date signed] for the spa service performed on this date, . [date service rendered]
Name of Minor: <CHILDFIRSTNAME> <CHILDLASTNAME>
Name of Parent/Guardian:
By Parent/Guardian: [Signature of Parent or Legal Guardian]
Date
CONSENT, INDEMNITY AND RELEASE/WAIVER
The undersigned, (“Undersigned”), parent/guardian of <CHILDFIRSTNAME> <CHILDLASTNAME> [minor’s name] (“Minor”) hereby consents to Minor’s receipt of spa services and releases from all liability all “Hiatus Spa + Retreat” entities, which include Hiatus LLC, Hiatus Austin LLC, Hiatus Plano LLC, Hiatus San Antonio LLC, Hiatus Houston LLC, Hiatus Fort Worth LLC, Hiatus Dallas 2 LLC, or Hiatus Frisco LLC (collectively “Hiatus”), related to Minor’s receipt of spa services from Hiatus.
1. Consent.
By submitting this Consent, Indemnity and Release/Waiver on Minor’s behalf, I am representing to Hiatus that both Minor and Undersigned, as Minor’s parent or guardian, consent to Hiatus rendering spa services to Minor in accordance with the Texas Administrative Code, Title 25, Part 1, Chapter 140, Subchapter H, Division 2, Rule 140.303, Letter F, which states, “A licensee must obtain the written consent of a parent or guardian to provide massage therapy services to a person under the age of 17.”
I understand Minor will be receiving a spa service from a circle one: male / female service provider and give my consent. I also acknowledge that, as Minor’s parent or guardian, I am required to be in the treatment room with Minor during any massage services.
Spa services include, but are not limited to, massage, nail therapy and facials. Further, I understand that Hiatus is relying upon this Consent, Indemnity and Release/Waiver and would not, without it, proceed to render spa services to Minor.
2. Indemnity.
Undersigned shall indemnify and hold harmless Hiatus and its respective owners, members, officers, agents, and employees against any claim, loss, damage, expense or liability resulting from or arising out of Hiatus’ rendering of spa services to Minor.
3. Release/Waiver.
Undersigned agrees that Hiatus and its respective owners, members, officers, agents, and employees shall not be liable to the undersigned, Minor or anyone purporting to act on behalf of Minor, for any injury to person or damage to property sustained by Minor or any person claiming through Minor resulting from any accident or occurrence in the course of Minor’s receipt of spa services from Hiatus.
In witness whereof, the parties have entered into this Consent, Indemnity and Release/Waiver as of this date, , [date signed] for the spa service performed on this date, . [date service rendered]
Name of Minor: <CHILDFIRSTNAME> <CHILDLASTNAME>
Name of Parent/Guardian:
By Parent/Guardian: [Signature of Parent or Legal Guardian]
Date
CONSENT, INDEMNITY AND RELEASE/WAIVER
The undersigned, (“Undersigned”), parent/guardian of <CHILDFIRSTNAME> <CHILDLASTNAME> [minor’s name] (“Minor”) hereby consents to Minor’s receipt of spa services and releases from all liability all “Hiatus Spa + Retreat” entities, which include Hiatus LLC, Hiatus Austin LLC, Hiatus Plano LLC, Hiatus San Antonio LLC, Hiatus Houston LLC, Hiatus Fort Worth LLC, Hiatus Dallas 2 LLC, or Hiatus Frisco LLC (collectively “Hiatus”), related to Minor’s receipt of spa services from Hiatus.
1. Consent.
By submitting this Consent, Indemnity and Release/Waiver on Minor’s behalf, I am representing to Hiatus that both Minor and Undersigned, as Minor’s parent or guardian, consent to Hiatus rendering spa services to Minor in accordance with the Texas Administrative Code, Title 25, Part 1, Chapter 140, Subchapter H, Division 2, Rule 140.303, Letter F, which states, “A licensee must obtain the written consent of a parent or guardian to provide massage therapy services to a person under the age of 17.”
I understand Minor will be receiving a spa service from a circle one: male / female service provider and give my consent. I also acknowledge that, as Minor’s parent or guardian, I am required to be in the treatment room with Minor during any massage services.
Spa services include, but are not limited to, massage, nail therapy and facials. Further, I understand that Hiatus is relying upon this Consent, Indemnity and Release/Waiver and would not, without it, proceed to render spa services to Minor.
2. Indemnity.
Undersigned shall indemnify and hold harmless Hiatus and its respective owners, members, officers, agents, and employees against any claim, loss, damage, expense or liability resulting from or arising out of Hiatus’ rendering of spa services to Minor.
3. Release/Waiver.
Undersigned agrees that Hiatus and its respective owners, members, officers, agents, and employees shall not be liable to the undersigned, Minor or anyone purporting to act on behalf of Minor, for any injury to person or damage to property sustained by Minor or any person claiming through Minor resulting from any accident or occurrence in the course of Minor’s receipt of spa services from Hiatus.
In witness whereof, the parties have entered into this Consent, Indemnity and Release/Waiver as of this date, , [date signed] for the spa service performed on this date, . [date service rendered]
Name of Minor: <CHILDFIRSTNAME> <CHILDLASTNAME>
Name of Parent/Guardian:
By Parent/Guardian: [Signature of Parent or Legal Guardian]
Date
CONSENT, INDEMNITY AND RELEASE/WAIVER
The undersigned, (“Undersigned”), parent/guardian of <CHILDFIRSTNAME> <CHILDLASTNAME> [minor’s name] (“Minor”) hereby consents to Minor’s receipt of spa services and releases from all liability all “Hiatus Spa + Retreat” entities, which include Hiatus LLC, Hiatus Austin LLC, Hiatus Plano LLC, Hiatus San Antonio LLC, Hiatus Houston LLC, Hiatus Fort Worth LLC, Hiatus Dallas 2 LLC, or Hiatus Frisco LLC (collectively “Hiatus”), related to Minor’s receipt of spa services from Hiatus.
1. Consent.
By submitting this Consent, Indemnity and Release/Waiver on Minor’s behalf, I am representing to Hiatus that both Minor and Undersigned, as Minor’s parent or guardian, consent to Hiatus rendering spa services to Minor in accordance with the Texas Administrative Code, Title 25, Part 1, Chapter 140, Subchapter H, Division 2, Rule 140.303, Letter F, which states, “A licensee must obtain the written consent of a parent or guardian to provide massage therapy services to a person under the age of 17.”
I understand Minor will be receiving a spa service from a circle one: male / female service provider and give my consent. I also acknowledge that, as Minor’s parent or guardian, I am required to be in the treatment room with Minor during any massage services.
Spa services include, but are not limited to, massage, nail therapy and facials. Further, I understand that Hiatus is relying upon this Consent, Indemnity and Release/Waiver and would not, without it, proceed to render spa services to Minor.
2. Indemnity.
Undersigned shall indemnify and hold harmless Hiatus and its respective owners, members, officers, agents, and employees against any claim, loss, damage, expense or liability resulting from or arising out of Hiatus’ rendering of spa services to Minor.
3. Release/Waiver.
Undersigned agrees that Hiatus and its respective owners, members, officers, agents, and employees shall not be liable to the undersigned, Minor or anyone purporting to act on behalf of Minor, for any injury to person or damage to property sustained by Minor or any person claiming through Minor resulting from any accident or occurrence in the course of Minor’s receipt of spa services from Hiatus.
In witness whereof, the parties have entered into this Consent, Indemnity and Release/Waiver as of this date, , [date signed] for the spa service performed on this date, . [date service rendered]
Name of Minor: <CHILDFIRSTNAME> <CHILDLASTNAME>
Name of Parent/Guardian:
By Parent/Guardian: [Signature of Parent or Legal Guardian]
Date
CONSENT, INDEMNITY AND RELEASE/WAIVER
The undersigned, (“Undersigned”), parent/guardian of <CHILDFIRSTNAME> <CHILDLASTNAME> [minor’s name] (“Minor”) hereby consents to Minor’s receipt of spa services and releases from all liability all “Hiatus Spa + Retreat” entities, which include Hiatus LLC, Hiatus Austin LLC, Hiatus Plano LLC, Hiatus San Antonio LLC, Hiatus Houston LLC, Hiatus Fort Worth LLC, Hiatus Dallas 2 LLC, or Hiatus Frisco LLC (collectively “Hiatus”), related to Minor’s receipt of spa services from Hiatus.
1. Consent.
By submitting this Consent, Indemnity and Release/Waiver on Minor’s behalf, I am representing to Hiatus that both Minor and Undersigned, as Minor’s parent or guardian, consent to Hiatus rendering spa services to Minor in accordance with the Texas Administrative Code, Title 25, Part 1, Chapter 140, Subchapter H, Division 2, Rule 140.303, Letter F, which states, “A licensee must obtain the written consent of a parent or guardian to provide massage therapy services to a person under the age of 17.”
I understand Minor will be receiving a spa service from a circle one: male / female service provider and give my consent. I also acknowledge that, as Minor’s parent or guardian, I am required to be in the treatment room with Minor during any massage services.
Spa services include, but are not limited to, massage, nail therapy and facials. Further, I understand that Hiatus is relying upon this Consent, Indemnity and Release/Waiver and would not, without it, proceed to render spa services to Minor.
2. Indemnity.
Undersigned shall indemnify and hold harmless Hiatus and its respective owners, members, officers, agents, and employees against any claim, loss, damage, expense or liability resulting from or arising out of Hiatus’ rendering of spa services to Minor.
3. Release/Waiver.
Undersigned agrees that Hiatus and its respective owners, members, officers, agents, and employees shall not be liable to the undersigned, Minor or anyone purporting to act on behalf of Minor, for any injury to person or damage to property sustained by Minor or any person claiming through Minor resulting from any accident or occurrence in the course of Minor’s receipt of spa services from Hiatus.
In witness whereof, the parties have entered into this Consent, Indemnity and Release/Waiver as of this date, , [date signed] for the spa service performed on this date, . [date service rendered]
Name of Minor: <CHILDFIRSTNAME> <CHILDLASTNAME>
Name of Parent/Guardian:
By Parent/Guardian: [Signature of Parent or Legal Guardian]
Date
CONSENT, INDEMNITY AND RELEASE/WAIVER
The undersigned, (“Undersigned”), parent/guardian of <CHILDFIRSTNAME> <CHILDLASTNAME> [minor’s name] (“Minor”) hereby consents to Minor’s receipt of spa services and releases from all liability all “Hiatus Spa + Retreat” entities, which include Hiatus LLC, Hiatus Austin LLC, Hiatus Plano LLC, Hiatus San Antonio LLC, Hiatus Houston LLC, Hiatus Fort Worth LLC, Hiatus Dallas 2 LLC, or Hiatus Frisco LLC (collectively “Hiatus”), related to Minor’s receipt of spa services from Hiatus.
1. Consent.
By submitting this Consent, Indemnity and Release/Waiver on Minor’s behalf, I am representing to Hiatus that both Minor and Undersigned, as Minor’s parent or guardian, consent to Hiatus rendering spa services to Minor in accordance with the Texas Administrative Code, Title 25, Part 1, Chapter 140, Subchapter H, Division 2, Rule 140.303, Letter F, which states, “A licensee must obtain the written consent of a parent or guardian to provide massage therapy services to a person under the age of 17.”
I understand Minor will be receiving a spa service from a circle one: male / female service provider and give my consent. I also acknowledge that, as Minor’s parent or guardian, I am required to be in the treatment room with Minor during any massage services.
Spa services include, but are not limited to, massage, nail therapy and facials. Further, I understand that Hiatus is relying upon this Consent, Indemnity and Release/Waiver and would not, without it, proceed to render spa services to Minor.
2. Indemnity.
Undersigned shall indemnify and hold harmless Hiatus and its respective owners, members, officers, agents, and employees against any claim, loss, damage, expense or liability resulting from or arising out of Hiatus’ rendering of spa services to Minor.
3. Release/Waiver.
Undersigned agrees that Hiatus and its respective owners, members, officers, agents, and employees shall not be liable to the undersigned, Minor or anyone purporting to act on behalf of Minor, for any injury to person or damage to property sustained by Minor or any person claiming through Minor resulting from any accident or occurrence in the course of Minor’s receipt of spa services from Hiatus.
In witness whereof, the parties have entered into this Consent, Indemnity and Release/Waiver as of this date, , [date signed] for the spa service performed on this date, . [date service rendered]
Name of Minor: <CHILDFIRSTNAME> <CHILDLASTNAME>
Name of Parent/Guardian:
By Parent/Guardian: [Signature of Parent or Legal Guardian]
Date
CONSENT, INDEMNITY AND RELEASE/WAIVER
The undersigned, (“Undersigned”), parent/guardian of <CHILDFIRSTNAME> <CHILDLASTNAME> [minor’s name] (“Minor”) hereby consents to Minor’s receipt of spa services and releases from all liability all “Hiatus Spa + Retreat” entities, which include Hiatus LLC, Hiatus Austin LLC, Hiatus Plano LLC, Hiatus San Antonio LLC, Hiatus Houston LLC, Hiatus Fort Worth LLC, Hiatus Dallas 2 LLC, or Hiatus Frisco LLC (collectively “Hiatus”), related to Minor’s receipt of spa services from Hiatus.
1. Consent.
By submitting this Consent, Indemnity and Release/Waiver on Minor’s behalf, I am representing to Hiatus that both Minor and Undersigned, as Minor’s parent or guardian, consent to Hiatus rendering spa services to Minor in accordance with the Texas Administrative Code, Title 25, Part 1, Chapter 140, Subchapter H, Division 2, Rule 140.303, Letter F, which states, “A licensee must obtain the written consent of a parent or guardian to provide massage therapy services to a person under the age of 17.”
I understand Minor will be receiving a spa service from a circle one: male / female service provider and give my consent. I also acknowledge that, as Minor’s parent or guardian, I am required to be in the treatment room with Minor during any massage services.
Spa services include, but are not limited to, massage, nail therapy and facials. Further, I understand that Hiatus is relying upon this Consent, Indemnity and Release/Waiver and would not, without it, proceed to render spa services to Minor.
2. Indemnity.
Undersigned shall indemnify and hold harmless Hiatus and its respective owners, members, officers, agents, and employees against any claim, loss, damage, expense or liability resulting from or arising out of Hiatus’ rendering of spa services to Minor.
3. Release/Waiver.
Undersigned agrees that Hiatus and its respective owners, members, officers, agents, and employees shall not be liable to the undersigned, Minor or anyone purporting to act on behalf of Minor, for any injury to person or damage to property sustained by Minor or any person claiming through Minor resulting from any accident or occurrence in the course of Minor’s receipt of spa services from Hiatus.
In witness whereof, the parties have entered into this Consent, Indemnity and Release/Waiver as of this date, , [date signed] for the spa service performed on this date, . [date service rendered]
Name of Minor: <CHILDFIRSTNAME> <CHILDLASTNAME>
Name of Parent/Guardian:
By Parent/Guardian: [Signature of Parent or Legal Guardian]
Date
CONSENT, INDEMNITY AND RELEASE/WAIVER
The undersigned, (“Undersigned”), parent/guardian of <CHILDFIRSTNAME> <CHILDLASTNAME> [minor’s name] (“Minor”) hereby consents to Minor’s receipt of spa services and releases from all liability all “Hiatus Spa + Retreat” entities, which include Hiatus LLC, Hiatus Austin LLC, Hiatus Plano LLC, Hiatus San Antonio LLC, Hiatus Houston LLC, Hiatus Fort Worth LLC, Hiatus Dallas 2 LLC, or Hiatus Frisco LLC (collectively “Hiatus”), related to Minor’s receipt of spa services from Hiatus.
1. Consent.
By submitting this Consent, Indemnity and Release/Waiver on Minor’s behalf, I am representing to Hiatus that both Minor and Undersigned, as Minor’s parent or guardian, consent to Hiatus rendering spa services to Minor in accordance with the Texas Administrative Code, Title 25, Part 1, Chapter 140, Subchapter H, Division 2, Rule 140.303, Letter F, which states, “A licensee must obtain the written consent of a parent or guardian to provide massage therapy services to a person under the age of 17.”
I understand Minor will be receiving a spa service from a circle one: male / female service provider and give my consent. I also acknowledge that, as Minor’s parent or guardian, I am required to be in the treatment room with Minor during any massage services.
Spa services include, but are not limited to, massage, nail therapy and facials. Further, I understand that Hiatus is relying upon this Consent, Indemnity and Release/Waiver and would not, without it, proceed to render spa services to Minor.
2. Indemnity.
Undersigned shall indemnify and hold harmless Hiatus and its respective owners, members, officers, agents, and employees against any claim, loss, damage, expense or liability resulting from or arising out of Hiatus’ rendering of spa services to Minor.
3. Release/Waiver.
Undersigned agrees that Hiatus and its respective owners, members, officers, agents, and employees shall not be liable to the undersigned, Minor or anyone purporting to act on behalf of Minor, for any injury to person or damage to property sustained by Minor or any person claiming through Minor resulting from any accident or occurrence in the course of Minor’s receipt of spa services from Hiatus.
In witness whereof, the parties have entered into this Consent, Indemnity and Release/Waiver as of this date, , [date signed] for the spa service performed on this date, . [date service rendered]
Name of Minor: <CHILDFIRSTNAME> <CHILDLASTNAME>
Name of Parent/Guardian:
By Parent/Guardian: [Signature of Parent or Legal Guardian]
Date
CONSENT, INDEMNITY AND RELEASE/WAIVER
The undersigned, (“Undersigned”), parent/guardian of <CHILDFIRSTNAME> <CHILDLASTNAME> [minor’s name] (“Minor”) hereby consents to Minor’s receipt of spa services and releases from all liability all “Hiatus Spa + Retreat” entities, which include Hiatus LLC, Hiatus Austin LLC, Hiatus Plano LLC, Hiatus San Antonio LLC, Hiatus Houston LLC, Hiatus Fort Worth LLC, Hiatus Dallas 2 LLC, or Hiatus Frisco LLC (collectively “Hiatus”), related to Minor’s receipt of spa services from Hiatus.
1. Consent.
By submitting this Consent, Indemnity and Release/Waiver on Minor’s behalf, I am representing to Hiatus that both Minor and Undersigned, as Minor’s parent or guardian, consent to Hiatus rendering spa services to Minor in accordance with the Texas Administrative Code, Title 25, Part 1, Chapter 140, Subchapter H, Division 2, Rule 140.303, Letter F, which states, “A licensee must obtain the written consent of a parent or guardian to provide massage therapy services to a person under the age of 17.”
I understand Minor will be receiving a spa service from a circle one: male / female service provider and give my consent. I also acknowledge that, as Minor’s parent or guardian, I am required to be in the treatment room with Minor during any massage services.
Spa services include, but are not limited to, massage, nail therapy and facials. Further, I understand that Hiatus is relying upon this Consent, Indemnity and Release/Waiver and would not, without it, proceed to render spa services to Minor.
2. Indemnity.
Undersigned shall indemnify and hold harmless Hiatus and its respective owners, members, officers, agents, and employees against any claim, loss, damage, expense or liability resulting from or arising out of Hiatus’ rendering of spa services to Minor.
3. Release/Waiver.
Undersigned agrees that Hiatus and its respective owners, members, officers, agents, and employees shall not be liable to the undersigned, Minor or anyone purporting to act on behalf of Minor, for any injury to person or damage to property sustained by Minor or any person claiming through Minor resulting from any accident or occurrence in the course of Minor’s receipt of spa services from Hiatus.
In witness whereof, the parties have entered into this Consent, Indemnity and Release/Waiver as of this date, , [date signed] for the spa service performed on this date, . [date service rendered]
Name of Minor: <CHILDFIRSTNAME> <CHILDLASTNAME>
Name of Parent/Guardian:
By Parent/Guardian: [Signature of Parent or Legal Guardian]
Date
CONSENT, INDEMNITY AND RELEASE/WAIVER
The undersigned, (“Undersigned”), parent/guardian of <CHILDFIRSTNAME> <CHILDLASTNAME> [minor’s name] (“Minor”) hereby consents to Minor’s receipt of spa services and releases from all liability all “Hiatus Spa + Retreat” entities, which include Hiatus LLC, Hiatus Austin LLC, Hiatus Plano LLC, Hiatus San Antonio LLC, Hiatus Houston LLC, Hiatus Fort Worth LLC, Hiatus Dallas 2 LLC, or Hiatus Frisco LLC (collectively “Hiatus”), related to Minor’s receipt of spa services from Hiatus.
1. Consent.
By submitting this Consent, Indemnity and Release/Waiver on Minor’s behalf, I am representing to Hiatus that both Minor and Undersigned, as Minor’s parent or guardian, consent to Hiatus rendering spa services to Minor in accordance with the Texas Administrative Code, Title 25, Part 1, Chapter 140, Subchapter H, Division 2, Rule 140.303, Letter F, which states, “A licensee must obtain the written consent of a parent or guardian to provide massage therapy services to a person under the age of 17.”
I understand Minor will be receiving a spa service from a circle one: male / female service provider and give my consent. I also acknowledge that, as Minor’s parent or guardian, I am required to be in the treatment room with Minor during any massage services.
Spa services include, but are not limited to, massage, nail therapy and facials. Further, I understand that Hiatus is relying upon this Consent, Indemnity and Release/Waiver and would not, without it, proceed to render spa services to Minor.
2. Indemnity.
Undersigned shall indemnify and hold harmless Hiatus and its respective owners, members, officers, agents, and employees against any claim, loss, damage, expense or liability resulting from or arising out of Hiatus’ rendering of spa services to Minor.
3. Release/Waiver.
Undersigned agrees that Hiatus and its respective owners, members, officers, agents, and employees shall not be liable to the undersigned, Minor or anyone purporting to act on behalf of Minor, for any injury to person or damage to property sustained by Minor or any person claiming through Minor resulting from any accident or occurrence in the course of Minor’s receipt of spa services from Hiatus.
In witness whereof, the parties have entered into this Consent, Indemnity and Release/Waiver as of this date, , [date signed] for the spa service performed on this date, . [date service rendered]
Name of Minor: <CHILDFIRSTNAME> <CHILDLASTNAME>
Name of Parent/Guardian:
By Parent/Guardian: [Signature of Parent or Legal Guardian]
Date