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Massage Practice Session Consent Form 


Please read before booking a practice session:

I understand that Tyehimba Kokayi is a massage therapy student and not yet a licensed therapist. 

Sessions are for practice and learning purposes only - not for diagnosis, treatment, or cure of any medical condition.

I agree to:
- Inform the student of any injuries, medical conditions, or areas to avoid-

-Communicate if I need anything adjusted or wish to stop the massage-

-Release the student from any liability related to this session.

By checking the box at the end of this form, I confirm that I have read and agree to the terms above.
Email *
Name *
Email *
Address *
Phone number *
Emergency Contact Name
 *
Emergency Contact Phone
 *
Medical conditions or injuries the student should know about? *
Allergies (especially to oils/lotions)
 *
Recent Illnesses or Skin Conditions?
 *
Areas you would like avoided?
 *
Are you Pregnant?
 *
Required
Photography/Video Release

I give permission for photos/videos of my session to be used for training or promotional purposes.
 *
Required
I have read and agree to the terms above
 *
Required
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