Let's Celebrate You

EBLUXE CARES – Caregiver Spa Day Confirmation Form

Location: Glen Ivy Hot Springs

Month: July 2025

First Name

Last Name

Phone

Emergency Contact Name

Emergency Contact Phone Number

Do you have any dietary restrictions?

If yes, Guest Name(s):

If yes, Guest Number(s):

If yes, Guest Email(s)

Optional: Any Health Conditions or Emergency Preferences we should know about?

MEDIA RELEASE PERMISSION: By checking the box, I give EBLUXE CARES permission to take and use photographs and/or video recordings during the spa day for promotional and storytelling purposes across digital and print platforms.

LIABILITY WAIVER: By signing below, I acknowledge that I am voluntarily participating in the EBLUXE CARES Caregiver Spa Day and release EBLUXE CARES and its affiliates from any liability associated with my participation. I understand spa services are provided by Glen Ivy Hot Springs and accept full responsibility for my health and safety during the event.

COMMUNICATION CONSENT: By providing my email address and/or phone number, I give EBLUXE CARES and it’s affiliate EBLUXE HAIR permission to contact me via email, phone, or text message regarding updates, event reminders, or promotional information. I understand I can opt out at any time.

Your Signature

Today's Date:

GUEST PAYMENT INFORMATION:

If you are bringing a guest, payment must be submitted to EBLUXE CARES prior to booking their experience.

Full Experience (includes massage or facial): $320

Everything above without massage or facial: $205

Please send payment via Zelle to: info@ebluxecares.org Include your name and the guest's name in the payment notes.

Thanks for submitting!