Minor Consent Form

Minors are permitted to receive massage in the clinic. Parents or legal guardians must be present in helping complete the Health History Form for the minor, along with consent for the massage therapy session.

Guidelines:

• All minor clients under the age of 18 can only receive massage with written parental/legal guardian consent.
• Parent/legal guardian should be in the treatment room during each session.
• In collaboration with the consenting adult and child, the massage therapist will assist in establishing goals for the sessions.
• Appropriate draping will always be used during the massage; only areas being massaged are uncovered.

I, {#qfb-element-25}, the parent/legal guardian of {#qf_Y_2}, have read the above information and give permission for my child, {#qf_Y_2}, to receive massage therapy from {#qf_Y_3}. {#qf_Y_4} (Parent/Legal Guardian Signature)      {#qf_Y_5} (Date)