Float Tank Release Form

Phone Number *
Phone Number
Address *
Address
Physician Phone Number
Physician Phone Number
Emergency Contact Phone Number *
Emergency Contact Phone Number
To ensure a comfortable, clean, safe floatation experience, I agree to the following (by checking the box, you are legally acknowleding the following information to be true): *
*If yes, please describe
If yes, please list medication, dosage, and condition:
Please check if you have or have had any of the following: *
*Otherwise ignore
I understand that the Floatation Tank uses: *
*Please Sign:
Date *
Date