Terria's Therapeutic Table and Chair Massage— Mobile Massage + Massage Tables Delivered On Demand
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Kidz @ Play Family Cafe Chair Massage Sign-Up 

By Terria Singleton, LMBT #23435 

Rates: • $20 for 10 mins or $30 for 15 mins

Waiver & Release: By signing up, I acknowledge chair massage is a non‑medical therapeutic service and I am participating voluntarily. I agree to inform the therapist of any discomfort and release Terria’s Therapeutic Table & Chair Massage (NC LMBT #23435) and the event host from any liability related to this service.
Name Phone E-mail
Choose Date (s) of Service
October 1, 2026 (Thursday)
October 8, 2026 (Thursday)
Time (Choose one only)
10:00 am
10:20 am
10:40 am
11:00 am
11:20 am
11:40 am
12:00 pm
Choose Duration
10 Minute Sessions
15 Minute Sessions
Choose The Focus Area (s)
Neck Only
Back Only
Arms Only
Hands Only
Neck, Back Only
Back & Arms Only
Neck, Back, Arms, Hands
Are you currently taking blood thinner medication?
Yes
No
Are you pregnant?
Yes
No
N/A, Male
Play Pen Option—Optional Parent Support: We offer a small, clean play pen right beside the massage chair for parents who need a safe spot for their little one during their session. Would you like to use the play pen during your massage?
Yes, I’ll need the play pen
No, I won’t need it
Payment Method
Invoice (Square Inc.)
Reoccurring Appointments
Yes, sign me for every Tuesday session at this time.
No, thanks I prefer to book my appointment as needed.
Message I agree to the Terms & Conditions and Privacy Policy Submit