Thanks for booking a float with us! If this is your first float with us, please complete the waiver below: First Name*Last Name*Email* Phone*Birthday*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Date of Float*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920What day will you be floating with us?AddressStreet Address*Address Line 2*City*State*StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZIP Code*Emergency ContactEmergency Contact*Emergency Contact*Emergency Contact Phone*Rules of Be Still Float Studio Consent 1* I agree that I can independently and safely transition from a lying to standing position.*Consent 2* I understand that using any self-tanning products or hair coloring or highlighting or applying henna to my body must be completed at least 7 days prior to floating. Please not brighter colors may require a longer waiting period - the color should no longer be bleeding onto towels when hair is wet. If you have questions regarding your hair dye please call us to consult. Contamination of the float tank solution with outside products, bodily fluids, hair dye, etc. is my financial responsibility (up to a total of $1,500). I am stating that I have absolutely no residual hair color/tint in my hair that could potentially wash out into your float tank solution.*Consent 3* I understand and will comply with the 48-hour rescheduling and cancellation policy. Within 24 hours notice will be charged the full amount of service fee. No shows will incur the full service fee.*Consent 4* I do not have a history of heart trouble, epilepsy, seizures, blackouts, panic attacks, mental illness, or kidney failure. If I do have any of these conditions, I have received consent from my physician. I agree not to float if I have a skin disease, infectious respiratory disease, and/or epilepsy until I can provide approval from my physician. Those with active or contagious respiratory diseases are not permitted. Customers cleared to float will complete a client consent/waiver prior to floating.*Consent 5* I agree not to float if I am under the influence of drugs or alcohol.*Consent 6* I agree to only use the soap and body wash provided prior to floating. I agree to shower thoroughly before my float, fully washing my hair and body, removing all make-up, perfumes, deodorants, etc., and rinsing all soap thoroughly from my hair and body before floating and then after the float session, even if I have just showered prior to arrival at Be Still Float Studio. Contamination of the float tank solution with outside products, bodily fluids, hair dye, etc. is my financial responsibility (up to a total of $1,500).*Consent 7* I agree to use grab bars where they are available to enter and exit the float tanks. Move slowly and step carefully.*Consent 8* I agree to exit the personal float space within 5-15 minutes after my float session ends to facilitate proper cleaning for the next guest.*Consent 9* I am choosing to use Be Still Float Studio of my own free will. I agree not to hold the facilities, operators or owners liable for any injury to self or for loss/damage of personal items.*Consent 10* I agree that if I contaminate the float tank solution, I will be held financially responsible for the replacement of the pharmaceutical grade magnesium sulphate and water at the charge of $1500.*Consent 11* I have read, understand and I agree to comply with all of the above rules, guidelines and regulations respectfully.*Signature*Did you book a float for someone other than yourself today?*YesNoUntitled Search Engine Friend Family Riverside Arts Market Southern Women’s Show Medical/Therapeutic Referral Whom may we thank for your referral? Facebook Instagram YouTube Co-Worker Newspaper Other: Subscribe It’s OK to send me an occasional email newsletter updating me on the latest news at Be Still Float Studio.