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ACKNOWLEDGEMENT SECTION CLIENT:

 By checking the box on this form, I acknowledge that I am electronically signing this “Informed Consent and Wavier”, I consent to receive therapy at 27 Gems LLC at 612 Washington Blvd Baltimore MD, or our location at 3401 Boston Street Baltimore MD and hereby agree to all policies of 27 Gems LLC, and waive and release 27 Gems LLC, & Merritt Clubs LLC, and its entire staff, massage therapists, and body work practitioners from any and all past, present, and future liability, loss, cost, claim, or damage whatsoever which may be imposed upon the Company relating to massage therapy and body work; including but not limited to Acupuncture, Fire cupping reflexology, acupressure, polarity therapy, energy therapy, Reiki, nutritional therapies, all forms of kinesiology, aromatherapy, craniosacral therapy, myofascial release therapy, trigger point therapy, stretching therapy, strength and condition training, among others. I further undertake to indemnify and hold 27 Gems LLC & Merritt Athletic Clubs LLC harmless from any incident(s) arising from my use of the 27 Gems LLC’s services. I agree to and acknowledge the foregoing on the day I sign and acknowledge this waiver.  If the client is less than 18 years old, the Client’s parent and natural guardian hereby represents that he/she is, in fact, acting in that capacity, has consented to his/her child or ward’s availing of the services of 27 Gems LLC, and has agreed individually and on behalf of the child or ward, to the terms of this “Informed Consent and Wavier”. The undersigned parent or guardian further agrees to save and hold harmless and indemnify 27 Gems LLC and Merritt Clubs LLC from all liability, loss, cost, claim, or damage whatsoever which may be imposed upon 27 Gems LLC or Merritt Athletic CLubs LLC relating to massage therapy and body work; including but not limited to Acupuncture, Fire Cupping, reflexology, acupressure, polarity therapy, energy therapy, Reiki, nutritional therapies, all forms of kinesiology, aromatherapy, craniosacral therapy, myofascial release therapy, trigger point therapy, stretching therapy, strength and condition training, among others, on behalf of the Client and all of the Client’s parents or legal guardians.

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