I acknowledge that my therapist, in returning to work, has confirmed to me that he/she has adhered to all health standards and guidelines set out by the Government of Saskatchewan relating to COVID 19.
The Therapist has confirmed to me that they have complied with all hygiene and practice standards imposed by the Massage Therapist Association of Saskatchewan (MTAS) or Natural Health Practitioners of Canada (NHPC). Notwithstanding the Therapist has complied with Personal Protection Equipment requirements and complies with the appropriate guidelines, the Therapist cannot guarantee there will be no contraction of COVID 19 arising out of treatment.
This form constitutes a release and waiver of the Therapist from liability should COVID 19 be contracted through treatment. I acknowledge I have been requested to execute this release and it is a condition of my receiving treatment from the Therapist, and failure to execute this Waiver and Release may result in treatment being refused.
1. I ACKNOWLEDGE and AGREE I understand the nature of the treatment I have requested.
2. I CONFIRM I am not currently showing any symptoms of COVID 19, and I have not, to my knowledge, contracted COVID 19, and I am aware of the COVID 19 symptoms.
3. I HEREBY RELEASE, WAIVE and DISCHARGE the Therapist, his/her administrators, employees, officers, agents, successors, heirs and assigns from all liability, actions, demands, and proceedings arising from my contracting COVID 19 as a result of my treatment.
4. I ACKNOWLEDGE I have read this Waiver and Release and fully understand its terms and I have signed it freely and without any inducement or assurance of any nature; and I intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law relating to my contracting COVID 19 from treatment. If any portion of this Waiver and Release is held to be invalid, the balance, notwithstanding, shall continue in full force and effect. I permit Damara Day Spa to release my name and contact information to the Saskatchewan Health Authority, for contact tracing purposes, in the event of a Covid exposure risk at the spa. This Waiver and Release shall be governed by and construed under the laws of the Province of Saskatchewan.
I understand that the therapist providing my massage therapy service is practicing within their scope of practice as defined by the governing bodies represented in Canada. I consent to assessment and treatment techniques recommended by the therapist and I acknowledge that the therapist is not a doctor. I acknowledge that no assurance or guarantee has been provided to me as to the results of the treatment. I acknowledge that with any treatment there can be risks and those risks have been explained to me and I assume those risks. I have completed my medical history to the best of my ability and have disclosed to the therapist all medical conditions affecting me, I assume the responsibility to keep my therapist updated on my medical conditions. By signing this form, I consent to treatment and intend this consent to cover the treatment discussed with me and such additional treatment as proposed by my therapist. I understand that at any time I may withdraw my consent and treatment will stop.I am aware of the 24-hour cancelation policy, If I fail to give 24-hour notice prior to my appointment, 50% of my service(s) will be charged on my credit card and for two hours before cancellation it will be 100% charge. I agree to be contacted periodically with special offers or services.