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Wellness Cafe
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Facility Closures Schedule
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Group Exercise Schedule
FORMS
VALLEY PAIN SPECIALISTS
DECK AT VALLEY
ABOUT US
Meet Our Managers
Membership Plans
Guest Policies & Forms
Employment Opportunities
Club photographs
VWC Gallery
NEWSLETTERS
FITNESS
Group Fitness Class Descriptions
Meet Our Personal Trainers
Indoor Triathlon
AQUATICS
Cabana Rental Request
Aquatic Policies
GREEN ROOM SALON & SPA
GRSS Menu
GRSS Hours
Appointment Cancellation Policy
KIDS & FAMILY
Birthday Party
Family Hours
Junior Fitness Schedule
Junior Martial Arts Signup Form
WELLNESS
Wellness Cafe
Chiropractic Care
SCHEDULES
Facility Closures Schedule
VWC 2023 Live Entertainment
Group Exercise Schedule
FORMS
GRSS Intake Form
vwc
2019-10-08T18:36:30+00:00
Welcome to Green Room Salon & Spa at Valley Wellness Center!
**Please note:
A tour is required
for all new salon/ spa prospects.**
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First Name
*
Last Name
*
Date of Birth
*
Phone Number
*
Email Address
*
Today's Date
*
Street Address
*
City
*
State
*
- Select Province/State -
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Northwest Territories
Nunavut
Ontario
Prince Edward Island
Quebec
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Yukon
====================
Alabama
Alaska
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Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
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Hawaii
Idaho
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Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
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New York
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Oregon
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South Carolina
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Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zipcode
*
How did you hear about us?
*
Facebook/Instagram
Google
Referral
Other
Please provide referral's name if applicable.
Please check all services you may be interested in experiencing at Green Room Salon & Spa:
*
Haircuts
Haircoloring
Massage
Facial
Microdermabrasion
Dermaplaning
Microneedling
Lash Tinting/ Lifting
Lash Extensions
Body Waxing
Manicure/ Pedicure
Botox/ Juvederm
Are you interested in receiving monthly specials in our salon/spa through VWC Membership?
*
Yes
No
How frequently do you visit a salon/spa?
*
Very Frequently (2-4 weeks)
Frequently (4-6 weeks)
Regularly (6-8 weeks)
Quarterly (8-12 weeks)
Occasionally (12+ weeks)
What do you hope to achieve through your service(s)?
Do you or any of your guests have any chronic pain or limitations on your activities of daily living?
*
Yes
No
If yes, do you have any interest in meeting with our on-site Chiropractor/Valley Pain Specialists for neck/back pain?
*
Yes
No
Do you have any allergies?
*
Yes
No
If yes, please explain.
Is there anything else you would like your service provider to know prior to beginning your service?
Assumption of Risk, Release and Indemnification:
*
I hereby acknowledge, accept and agree that fitness related activities involve inherent risks. I have received full information regarding VWC facilities and have had the opportunity to ask any questions that I wished. Participation in Activity carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. The specific risks vary from one activity to another, but the risks range from 1) minor injuries such as scratches, bruises, and sprains to 2) major injuries such as eye injury or loss of sight, joint or back injuries, heart attacks, and concussions to 3) catastrophic injuries including paralysis and death. In consideration of my use VWC facilities and/or participation in any program or competition by or held at VWC facilities, I hereby release and discharge VWC, their officers, owners, affiliates, agents and employees from any and all liabilities, suits, claims, demand actions or damages (including attorneys’ fees and disbursement), and losses or costs of any nature whatsoever incurred by me or that are in any way related to or arising out of the use or intended use of VWC facilities whether supervised or not, including, without limitation, all claims for property damage, personal injuries or wrongful death including any such claims which allege negligent acts or omissions of VWC.
**Please note: A tour is required for all new salon/ spa prospects.**
Electronic Signature
*
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