Minor Waiver

This form must be completed by the parents or guardian for any client under the age of 18. Please read the section below in its entirety before signing.

By signing below, you agree that you are the parent/legal guardian of the minor receiving treatment(s) at our facility. You understand that you are required to remain at the facility for the entirety of the minor's treatment(s). You will also be required, if needed, to assist the minor in preparing for his/her treatment(s). We may also request that you remain in the treatment room to supervise all interactions between the therapist and the minor.

You also agree that you have completed the Intake Form and have informed the therapist of all medical diagnoses, symptoms, medications, and complaints associated with the minor receiving treatment(s).

Parent/Guardian First Name

Parent/Guardian Last Name

Minor First & Last Name

Age of Minor

Relationship to minor

I certify that I am the parent or legal guardian of the above mentioned minor. I have completed the Intake Form and informed the therapist of all relevant medical history and concerns. I understand the scope of massage therapy/esthetics and that it is not meant to diagnose, treat, or cure any conditions and is not a replacement for standard medical care. I give permission for my minor child to receive treatment(s) at this facility and agree to all above terms.

Click the box to acknowledge that you have read and understand the above statement.

Signature

God's Healing Hands

Minor Waiver

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