g u e s t p r o f i l e f o r s k i n c a r e
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?
Are you currently under the care of a health professional for injuries/medical treatment/pregnancy?
Yes No
If yes, please explain:
HAVE YOU HAD - OR ARE YOU CURRENTLY TAKING - ANY OF THE FOLLOWING?
s k i n p e e l i n g i n f o r m e d c o n s e n t
I acknowledge there is a possibility of allergic reaction and I have thoroughly discussed with my skincare therapist any such reactions and understand them. I have had a patch test and it is negative, or I am foregoing a patch test and understand there could be an allergic response. I have been advised that my treatment is a non-invasive, light epidermal exfoliation possibly consisting of but not exclusive to: AHA, Glycolic, BHA or Plant-Based. The use of the these ingredients stimulates the skin to generate new skin cells and new collagen formation and increases blood circulation to the skin. I acknowledge that during application I will notice a warm sensation and the skin may tingle, sting or burn. This is a normal reaction; the face may appear frosted or sunburned. I acknowledge that I have not been on Accutane for the past six months. I acknowledge that I have not been using Retin A or Renova for the past two weeks. I acknowledge that if I am prone to cold sores that this treatment could bring about new cold sores.
w a x i n g a n d t i n t i n g i n f o r m e d c o n s e n t
I understand the information given on this questionnaire is strictly confidential and will be used for no other purpose than to assist the Esthetician in providing a suitable waxing or tinting session which will take into consideration my specific requirements. I also understand that failure on my part to disclose information could result in injury and/or illness and I hereby release Hiatus Spa + Retreat from any claims resulting from such.
h y d r a f a c i a l + d e r m a f r a c i n f o r m e d c o n s e n t
I acknowledge that after my Hydrafacial or DermaFrac procedure, all treated areas may experience temporary irritation, tightness, redness or slight swelling which should dissipate within 72 hours depending on skin sensitivity. I acknowledge that if I’m prone to cold sores or fever blisters, I will need to avoid treatments during a breakout. I will avoid using glycolic acid or Retin-A type products for 7 days before, the day of, and the day after my treatment.
N u F A C E i n f o r m e d c o n s e n t
I am aware of and understand that the NuFACE Trinity Devices deliver low-level electrical microcurrent impulses to the face. I acknowledge that I do not have the following conditions which are considered contraindications to the use of these devices; epilepsy or seizures, thyroid problems, light sensitivity, active cancer, the use of systemic or topical steroids, a pacemaker or other electrical implanted devices, recent facial surgery, or pregnancy.
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. The service providers are licensed Estheticians, Massage Therapists and Nail Therapists. They are not medically trained nor will they offer medical advice or diagnoses. The services provided by Hiatus Spa + Retreat are not a substitute for medical treatment.
To ensure an enjoyable experience, we request that you inform your service provider of any pre-existing conditions, limitations, or specific sensitivities. Please understand that it is vital to your experience at Hiatus to inform your service provider if you feel any discomfort during the session.
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. Please initial:
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.
a t i p 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: $23 - $35 | 120 minutes: $28 - $45
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.
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