MVPR Therapy 10-Minute Treatment Waiver

Please complete before your demo session.

First name

Last name

Phone (optional)

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 lululemon x Girls Forward event is not a full clinical service. Participation is voluntary and at my own risk. I release MVPR Therapy, its therapists, staff, lululemon, The Cadillac Fairview Corporation Limited 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

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

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

HOURS OF OPERATION.

LOCATIONS & CONTACT.

MENU.