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If you have travlled outside of the UK, please state what country/ies you have travelled to, {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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If you have ticked any of these boxes after reading this list, you are classed as extremely vulnerable and the government advise that you exercise ‘shielding’.
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If you tick any boxes after reading this list, you are at moderate risk from coronavirus and it is very important you follow the advice on social distancing.
Consent for receiving a treatment/s with a practitioner from Glo Pamper Ltd.
I declare that the information I have provided is correct to the best of my knowledge and I understand that, because my treatment may involve touch and close physical proximity over a period of time, there may be an elevated risk of disease transmission, including Covid-19.
I consent to the Glo therapist retaining the details provided on this form for a period of 7 years from today. I further understand that if I am under 18 years of age*, these records will be kept until I reach the age of 25 (7 years after reaching 18).
I give my consent to receive treatment from the therapist assigned to my booking by Glo Pamper Ltd.
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Contact information herein will not be used for any other purpose other than specifically for this booking between Glo and your Glo Therapist.