Spiritual/Energy Session Waiver

Fields marked with * are required

First Name*

Last Name*

Your Email*

Age*

DOB*

Address*

Zip Code*

Cell Phone*

Who referred You?*

Profession?*

Emergency Contact Name*

Emergency Phone*

Relationship*

We make every reasonable effort to provide and ensure a comfortable, clean and safe floating environment for you and ask that you comply with all of our directives and procedures. Please read and initial or check each of the follow statements of this agreement and sign below.

What brings you to want a spiritual/chakra/reiki session?:*

On a scale of 1-10, 1 being no pain, and 10 being crazy horrible pain, where are you today?*

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• 10

What do you currently do to alleviate the above concerns?

Check the boxes below*

• I hereby agree to irrevocably hold harmless and waive any claims that I now may have or may have hereafter against Kalyn Wolf Consulting LLC DBA Cloud Nine Flotation, its owner, employees, agents and dependents.
• I agree to the Cloud Nine Flotation Return, Cancellation and No Show Policies on the website and on paper.

If you are over 18 please sign below. If under 18 your parent or guardian must sign for you.

Type in Name for Digital Signature*

Current Date*