Interior of a massage room with two massage tables, overhead straps, soft lighting, potted plants, and a comfortable chair.

Women practicing Ashiatsu massage using ceiling bars with clients on massage tables in a spa setting.

After completing the below form, you will receive your login information for the online portion of the class. There you will find information about what to bring to class and what to read before class.

If you have not yet registered, please return to “classes” to register before completing this form.

Level 1 Waiver

Name

First Name

Last Name

Phone

(###)

###

####

Massage License

enter your state and license number. Students can enter their school name and graduation date.

Please enter the class date

Enter the first day of class.

YYYY

Health Information

Height

Weight

Do you have any health concerns that may prevent you from receiving deep bdywork for several hours each day?

yes

If yes, please explain

Photo Release

I hereby grant to Photographer (Mariah Maven), her legal representatives, heirs, and/or assigns those for whom Photographer is acting, and those acting with his/her authority and permission (collectively “Photographer”), the absolute right and permission to copyright and use, re-use, and publish photographic portraits or pictures of me or in which I may be included, in whole or in part without restriction as to changes or alterations from time to time, in conjunction with my own or a fictitious name, or reproductions thereof in color or otherwise, made through any medium at his/her studios or elsewhere, and in any and all media now or hereafter known, for art, advertising, trade or any other legal purpose. I also consent to the use of any printed matter in conjunction therewith. I hereby waive any right that I may have to inspect or approve the finished product or products or the advertising copy or printed matter that may be used in connection therewith or the use to which it may be applied. I hereby release, discharge, and agree to hold harmless Photographer from any and all liability that has or may occur or be produced in the taking of said pictures or any subsequent process thereof, as well as any publication thereof. I acknowledge that I am at least 18 years old, and have the right and ability to consent to the terms herein, and further, that I am authorized and able to sign on behalf of all persons listed above as Model(s).

I have read, understood, and agree to the terms of this Release.

Liability Waiver

This agreement releases THE SPACE Spokane LLC and Mariah Maven from all liability relating to injuries that may occur in SoleMassage continuing education courses, internship training, intensive seminars, and private mentorship. By signing this agreement, I agree to hold THE SPACE Spokane LLC and Mariah Maven entirely free from any liability, including financial responsibility for injuries incurred, regardless of whether injuries are caused by negligence. I also acknowledge the risks involved in providing and receiving barefoot massage and using the overhead support system and straps in a learning environment. The risks in giving and receiving the SoleMassage technique for extended increments of time over a short period of days include, but are not limited to stiffness, soreness, redness, skin irritation, headaches, sinus congestion, bruises, or any condition due to residual effects of giving and receiving deep tissue, trigger point, myofascial release and range of motion massage techniques. I understand that any information provided regarding the installation of the overhead support systems and straps constitutes part of this disclaimer. THE SPACE Spokane LLC and any of their instructors accept no liability for my own installation of an overhead support system or for their use outside of this training facility. By signing below I forfeit all rights to bring a suit against THE SPACE Spokane LLC or Mariah Maven for any reason. In return, I will receive continuing education hours for attending this course. I will also make every effort to obey safety precautions as listed in writing and as explained to me verbally. I will ask for clarification when needed.

I swear that I am participating voluntarily and that all risks have been made clear to me. Additionally, I do not have any conditions that will increase my likelihood of experiencing injuries while engaging in this activity.

Thank you!

Once you hit "submit" you will receive information on how to log into your online content. If you have questions or need assistance please contact Mariah mariah@spokanespace.com

Level 2 Waiver