MVPR Therapy 10-Minute Treatment Waiver

Please complete before your demo session.

First name

Last name

Phone (optional – note: only used for prize contact or urgent communication)

Have you been hospitalized in the last 12 months?

Yes

Are you suffering from a medical condition, illness or injury?

Yes

If you answered yes to any of the questions above, please supply additional information.

I understand that the demo treatment I receive at the Toronto Korean Festival is not a full clinical service. Participation is voluntary and at my own risk. I release MVPR Therapy, its therapists, staff, the Toronto Korean Festival, the Korean Canadian Business Association of Ontario, the City of Toronto, and all event sponsors and partners from any liability for injury, accident, or health issues that may occur.

I confirm that the answers I have provided to the health questions above are true and accurate, and I accept responsibility for disclosing any condition that may affect my safe participation in this demo treatment.

Signature

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By signing above, I confirm that I have read and agree to the waiver and release of liability above, that the health information I have provided is true and accurate, that I am at least 18 years of age, and that my participation in this demo treatment is voluntary and at my own risk.

MVPR Therapy 10-Minute Treatment Waiver

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