If you're under the age of 18 years, permission must be obtained from a parent or legal guardian before your massage treatment can begin.

Minor Child info
(to be completed if client is under the age of 18 years)
Minor's Name *
Minor's Name
Minor's Birthdate *
Minor's Birthdate
Minor's Phone
Minor's Phone
Parent/Legal Guardian info
Parent 1's Name *
Parent 1's Name
Parent 1's Phone *
Parent 1's Phone
Parent 2's Name
Parent 2's Name
Parent 2's Phone
Parent 2's Phone
Minor Informed Consent
Read the fine print below, and then "sign" on the dotted line.
I give permission to provide my minor child/person under my guardianship with therapeutic massage services as deemed appropriate to treat presenting conditions/injuries. I understand that I am financially responsible for the minor, and that all statements contained in this consent apply equally to both me and the minor. *
My child/person under my guardianship has my permission to appear for treatment without me present and I further understand that I must make the appointments.
Typing your first and last name between forward slashes [/] acts as your signature. For example: /Jane Smith/