Book an Appointment Parent/Caregiver's Name * First Name Last Name Parent/Caregiver's Email * Parent/Caregiver's Cell Phone * (###) ### #### Race/ethnicity that best describes the parent/caregiver * American Indian / Alaska Native Asian Black / African American White - Non-Hispanic White - Hispanic Hispanic / Latino Native Hawaiian / Pacific Islander Multi-Racial Middle Eastern / North African Other Prefer not to say Warrior's Name * Warrior's Hospital * Select the appointment you are interested in * Selecting a time slot does not guarantee your spot, a team member will reach out if you are selected Massage on September 9th from 10:00 - 11:00 am Massage on September 9th from 11:15 - 12:15 pm Massage on September 16th from 10:00 - 11:00 am Massage on September 16th from 11:15 - 12:15 pm Massage on September 23rd from 10:00 - 11:00 am Massage on September 23rd from 11:15 - 12:15 pm Massage on September 30th from 10:00 - 11:00 am Massage on September 30th from 11:15 - 12:15 pm SMS Opt-In By checking the box, I give permission to be contacted about Amanda Hope Rainbow Angels by SMS text at my residential or cellular number, dialed manually or by autodialer (consent to be contacted is not a condition to participate) and to be contacted via email. I consent to be contacted even if my phone number or email address appears on an Amanda Hope Rainbow Angels Do Not Call / Do Not Email List, a State or National Do Not Call Registry, or any other Do Not Contact List. Media Consent By checking this box, I give my permission for Amanda Hope Rainbow Angels and/or its representatives to use artwork, photographs and/or letters that I provide of my child, my family, and/or myself in publications, slides, videotapes, motion pictures and/or on the Internet. In addition, I hereby give my permission for Amanda Hope Rainbow Angels and/or its representatives to photograph, audio tape record, and/or videotape my child or myself and to use our names, these images or voice recordings in publications, slides, videotapes, motion pictures and/or on the internet. I understand these visual images or voice recordings may be used to inform families, volunteers, donors, the media and general public about Amanda Hope Rainbow Angels programs, services or events. I gladly give this authorization to support the efforts of Amanda Hope Rainbow Angels. I understand this authorization shall continue until terminated in writing. Providing consent is not a requirement in order to participate in Amanda Hope Rainbow Angels programs. Service Policy * By checking this box, I understand and acknowledge that I am choosing to volunteer to receive complimentary holistic health services. I do not have to participate in anything I choose not to. I will disclose any questions or concerns to my practitioner prior to participating in the session. All services provided are in NO way meant as a substitution for any current physical therapy, psychotherapy, counseling or medications being taken. Lastly, I understand that by participating in this experience, I hold Amanda Hope Rainbow Angels, Southwest Institute of Healing Arts, and any other participating organizations harmless for any incidents or injury that may occur. I am electing to participate and have been made fully aware of what is expected. Attendance Policy * By checking this box, I agree to comply with the written policy below. By completing this form, I am registering for this Amanda Hope Rainbow Angels event. If at any point, I am no longer able to attend the event, I will immediately notify the Amanda Hope team via email (hello@amandahope.org) or phone (602-775-5090). If I do not notify the organization before the event and do not show up at the event, I acknowledge that I will not be allowed to attend the next event. If the behavior continues, I acknowledge that I will be evaluated on an individual basis and may have all event attendance privileges revoked. If there is a medical emergency that causes me/my family to miss an event and I am unable to notify the Amanda Hope team beforehand, I agree to advise the Amanda Hope team at the next available opportunity. Thank you so much for signing up for a massage appointment! Our mindfulness coordinator will reach out if you are selected for this appointment.
