PH3AGREE

MSSP 2009 Project Helping Hands
A program of the Multiple Sclerosis Society of Portland, Oregon, Inc.

Client Agreement and Consent Form

   I wish to participate in the Multiple Sclerosis Society of Portland, Oregon Inc.’s (MSSP) massage program entitled, Project Helping Hands. By signing this form I understand and agree to:

1.   I certify that I have been diagnosed with multiple sclerosis.

2.   My physician has approved my participation in the program.

3.   Keep all regularly scheduled appointments.

4.    I will call my volunteer and give a minimum of 24 hours advance notice if I must cancel an appointment.

5.   To notify my volunteer if I am experiencing any pain, tremors or muscle weakness.

6.   The purpose of these visits is for “comfort only” and they are not meant to replace physical therapy.

Furthermore, I hereby release and forever discharge the Multiple Sclerosis Society of Portland, Oregon, Inc., its agents, servants, volunteers, employees, officers and directors, of and from any and all legal actions associated with my participation in “Project Helping Hands”. This consent form is intended to be legally binding.

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clients/ph3agree