Prenatal Acknowledgement and Waiver

    Reflexology, massage, and floating all offer many wonderful benefits for expectant mothers. These services during pregnancy are contraindicated for women experiencing any of the following symptoms/signs: 
    • Bloody discharge 
    • Continual abdominal pains 
    • Sudden gush or leakage of amniotic fluid 
    • Sudden, rapid weight gain 
    • Increased blood pressure 
    • Protein or sugar in urine 
    • Severe back pain that does not subside with the change in position 
    • Visual disturbances 
    • Severe nausea and/or vomiting 
    • Severe headaches 
    • Excessive hunger and thirst 
    • Increased urination in the second trimester 
    • Fever 
    • Diarrhea 
    • Excessive swelling in your arms or legs 
    • A decrease in fetal movement over a twenty-four hour period 
    • Heightened skin sensitivity or change in skin condition such as increase and/or decrease in sebum production, acne and hyperpigmentation. 
    • Some additional conditions that contraindicate massage therapy are any phlebitis, thrombosis, or suspected clotting conditions, any kidney, liver or spleen compromise or infection. Local massage on areas with severe varicose veins and swelling are avoided due to clotting risk. 

    It is a strict policy of Metta Relaxation Co. to require a signed doctor's release form in order for the guest to receive services if a guest has a high risk pregnancy. High risk pregnancies include, but are not limited to:
    • Early labor, miscarriage threat, placental or cervical dysfunction
    • Gestational Edema Proteinuria Hypertension (GEPH)
    • Eclampsia
    • Gestational Diabetes
    • Pre-existing cardiac, renal connective tissues or liver disorders/diseases
    • Fetal genetic disorders
    • Complications in previous pregnancies
    • Three or more miscarriages
    • Multiple birth pregnancy

    I have received and read the information written below about the benefits and possible contraindications of reflexology, massage and floating services during pregnancy. I understand the information and confirm that: 
    • I am experiencing a low-risk pregnancy; 
    • I have not experienced any of the complications or conditions listed on the next page, which would make it unwise to have reflexology, massage and floating services; 
    • I am receiving medical care including regular check-ups throughout my pregnancy; 
    • My physician has said it is safe for me to receive prenatal reflexology, massage and/or floating services. 

    I understand that I will be receiving massage therapy and/or skincare services as a form of adjunctive health care only and that this therapy is not intended to replace appropriate medical care. 

    Having been fully advised of the risks, contraindications, and complications of reflexology, massage and floating services during pregnancy, I have decided to participate in the service. Accordingly, I do forever release Metta Relaxation Co., its owners, the practitioners and their insurers, as well as their respective officers, directors, stockholders, successors, employees and agents from all liability of any nature whatsoever, whether past, present, or future, for injury or damage which may occur to myself or my family as a result of my receiving reflexology, massage and/or floating services during this childbearing year. 

    I further agree to hold harmless and defend the practitioner of and from all actions, claims, or other legal or administrative action that has arisen or may arise directly from my and my child’s participation in this service.

    I hereby waive and release, indemnify, hold harmless and forever discharge Metta Relaxation Co.  and its agents, employees, officers, directors, affiliates, successors and assigns, of and from any and all claims, demands, debts, contracts, expenses, causes of action, lawsuits, damages and liabilities, of every kind and nature, whether known or unknown, in law or equity, that I ever had or may have, arising from or in any way related to my participation in any of the events or activities conducted by, on the premises of, or for the benefit of Metta Relaxation Co.  provided that this waiver of liability does not apply to any acts of gross negligence, or intentional, willful or wanton misconduct.

    I understand that the activities that I will participate in are inherently dangerous and may cause serious or grievous injuries, including bodily injury, damage to personal property and/or death. On behalf of myself, my heirs, assigns and next of kin, I waive all claims for damages, injuries and death sustained to me or my property, that I may have against the aforementioned released party to such activity.

    By this Waiver, I assume any risk, and take full responsibility and waive any claims of personal injury, death or damage to personal property associated with Metta Relaxation Co.  including but not limited to using the facility and its equipment in any manner, form or fashion. Use of the facility and its equipment includes but is not limited to mean use of building entrance, lounge area, treatment rooms, restrooms, or float rooms.

    The provision of this waiver and release will continue in full force and effect even after the termination of the activities conducted by, on the premises of, or for the benefit of Metta Relaxation Co., whether by agreement, by operation of law, or otherwise.

    I have read, understand and fully agree to the terms of this waiver and release. I understand and confirm that by signing this waiver and release I have given up considerable future legal rights. I have signed this Agreement freely, voluntarily, under no duress or threat of duress, without inducement, promise or guarantee being communicated to me. Entering my information below is proof of my intention to execute a complete and unconditional waiver and release of all liability to the full extent of the law. I am 18 year of age or older and mentally competent to enter into this waiver.

    ELECTRONIC ACCEPTANCE
    By entering your information below, you are accepting the acknowledgement and waiver agreement.