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Retreat Guest Form

Please note; do not use auto-fill when completing this waiver or the form will not submit. Thank you.

Retreat Location

Health History

List any known food allergies and your dietary requirements.

Please note this retreat is vegetarian and vegan, no meat or fish will be served. 


Nervous System

Please explain any of the conditions that you have marked above:

Any other medical condition(s) not listed:

Is there anything else you wish to share with us?

client agreement

It is my choice to receive massage therapy. I am aware of the benefits and risks of massage and give my consent for massage. I understand that there is no implied or stated guarantee of success of effectiveness of individual techniques or series of appointments. I acknowledge that massage therapy is not a substitute for medical care, medical examination or diagnosis. I have stated all medical conditions that I am aware of and will inform my practitioner of any changes in my health status. 

terms & conditions
By attending this retreat with Massoga® Pty Ltd I agree its owners, teachers and any person employed by Massoga® Pty Ltd are in no way responsible for the safekeeping of my personal belongings. I understand that classes may be physically strenuous, I will be adjusted and massaged, and I voluntarily participate in this with full knowledge that there is risk of personal injury, property loss or death. I agree that neither I, my heirs, assigns or legal representatives will sue or make any other claims of any kind whatsoever against Massoga® Pty Ltd or its members for any personal injury, property damage/loss, or wrongful death, whether caused by negligence or otherwise.

photo release

Massoga® Pty Ltd uses images and sounds of persons enjoying immersions, trainings and events, and participating in photoshoots in support of its educational mission, or for marketing purposes. Massoga® Pty Ltd does not identify any person by name, unless it has received specific written permission to do so. In consideration of the above, I hereby grant Massoga® Pty Ltd permission to photograph, film, and make audio and/or video recordings of, me, and to use and display these on Massoga® Pty Ltd website, archives, and promotional and/or informational material, and in any and all media. I hereby waive and release any right to compensation for, or ownership of, such photograph(s), film(s), and audio and/or video recording(s) of me and the above uses of them by Massoga® Pty Ltd.

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