Full Name *

First Name

Last Name

Contact Number *

Country

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Confrirmed Date *

MM

DD

YYYY

Confirmed Time *

Hour

Minute

Second

AM PM

Duration of Appointment *

1 Hour

2 Hours

3 Hours

Over Night - 18 Hours

Custom Time Frame

Payment Method *

Which method did you pay the deposit by?

Beem

Bank Transfer

Squarespace Link

Confidentiality *

You agree to maintain the confidentiality of the appointment details and personal information shared.

Yes

No

Conduct *

The client agrees to conduct themselves in a respectful and courteous manner at all times.

Yes

No

Health and Safety *

Do you agree to adhere to the highest standards of health and safety?

Yes

No

Partial Payment *

Do you understand that partial payment is required as per the agreed terms prior to the commencement of the appointment?

Yes

No

Liability *

Do you understand that Riley Rose is not liable for any loss or damage of personal property or any personal injury sustained during the appointment?

Yes

No

Agreement To Terms *

Do you understand that by completing this form you, the client, agree to all of the terms and conditions stated above?

Yes

No

Signature *

Please fill out your full name

First Name

Last Name

Date *

MM

DD

YYYY