CSMT Application

 

Fields marked with an * are required

Thank you for your interest in the Community Services Massage Team. Please complete this form.

This application may be returned by printing the file located here, completing it and sending it to: AMTA-NY Chapter Office, 167 Chamberlain Rd., Honeoye Falls, NY 14472

Reminder - All CSMT Volunteers MUST have a Code of Conduct on File at the National Office as a Chapter Volunteer.

Follow this link to complete the Code of Conduct. When you click on the link you will need to log on with your National AMTA login information. After clicking on the link, check the box for Chapter Volunteer.

Contact CSMT Chair, Samantha Paige Graeber at ladystar44@icloud.com with any questions.





In the event of an emergency please list a contact:


WAIVER AND RELEASE

I represent that I am physically fit, that I am medically able to participate, and that I have no condition or other restriction (including use of medication) that would limit my participation in the Community Service Massage Team Emergency Response or Outreach Division. I understand and agree that I participate at my own risk.

I HEREBY RELEASE, WAIVE, AND FOREVER DISCHARGE ANY AND ALL CLAIMS AGAINST THE AMERICAN MASSAGE THERAPY ASSOCIATION, ITS CHAPTERS, DIRECTORS, OFFICERS, VOLUNTEERS, STAFF, REPRESENTATIVES, AND SUCCESSORS (COLLECTIVELY, “AMTA”) FOR DEATH, INJURY, LOSS AND ANY AND ALL DAMAGES WHICH I OR MY HEIRS, SUCCESSORS, ASSIGNS, AND REPRESENTATIVES MAY SUSTAIN AND/OR SUFFER IN CONNECTION WITH MY PARTICIPATION IN THE COMMUNITY SERVICE MASSAGE TEAM EMERGENCY RESPONSE OR OUTREACH DIVISION ACTIVITIES.

I understand that AMTA or its representatives have the right to refuse or discontinue my participation at any time in their sole discretion.

I consent to allow any audio, photos, videos or other images taken of me at the event to be used by AMTA or its agents, as it wishes, without compensation or restriction.

I represent that I am at least 18 years old.

Follow this link to complete the Code of Conduct.