I understand that this class is not accredited to offer continuing education credits, transfer credits nor am I licensed after this course to offer massage to the general public or anyone else for money or trade. Promoting myself as a massage therapist without licensure by the state is not legal in Louisiana. This is a community course designed for individual and group enrichment. *

I agree

I will not attend class if in the past 48 hours I have experienced fever, respiratory or flu symptoms, sore throat, or shortness of breath. *

I agree

I understand that, because massage therapy work involves maintained touch and close physical proximity over an extended period of time, there may be an elevated risk of disease transmission, including COVID-19. By signing this form, I acknowledge that I am aware of the risks involved from receiving or giving treatment at this time, I voluntarily agree to assume those risks, and I release and hold harmless the practitioner/business/other students from any claims related thereto. *

I agree

I give my consent to receive treatment from this practitioner and all students on this date and on any date thereafter. *

I agree

If I experience any pain or discomfort during this session, giving or receiving massage therapy, I will immediately inform the practitioner so that the pressure, techniques and/or strokes may be adjusted to my level of comfort. *

I agree

I understand that massage/bodywork should not be construed as a substitute for medical examination, diagnosis, or treatment and that I should see a physician, chiropractor, or other qualified medical specialist for any mental or physical ailment of which I am aware. *

I agree

I understand that massage/bodywork practitioners and students are not qualified to perform spinal or skeletal adjustments, diagnose, prescribe, or treat any physical or mental illness, and that nothing said in the course of the class should be construed as such. *

I agree

Because massage/bodywork should not be performed under certain medical conditions, I affirm that I have stated all my known medical conditions and answered all questions honestly. I agree to keep the teacher and other students updated as to any changes in my medical profile and understand that there shall be no liability on the practitioner’s or instructor’s part should I fail to do so. *

I agree

I agree to hold harmless Kate Olandra Lickter or her business, Olandra Lickter LLC, should any injury occur while on the premises for this class. *

I agree

I also understand that any illicit or sexually suggestive remarks or advances made by me will result in immediate termination of my participation in class, and I will be liable for payment of the scheduled course. *

I agree

Any form of harassment, bullying, exclusionary or derogatory remarks will also be means for termination from class. *

I agree

Understanding all of this, I give my consent to receive care and practice on others. *

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Last Name

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