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Get Minor Consent Form

Minor Consent Form Minors are permitted to receive massage in the clinic. Parent or legal guardian must be present in helping complete the Health History Form for the minor along with consent for the massage therapy session. Guidelines Minors all clients under the age of 18 unless otherwise emancipated can only receive massage with written parental/legal guardian consent. In collaboration with the consenting adult and child the massage therapist will assist in establishing goals for the session s. For clients age 15 and under the parent/guardian must always be present in the treatment room* comfortable with the child being in the session room by themselves please initial here. Otherwise parent/guardian should be in the treatment room during each session* Once a comfortable therapeutic relationship has been established and the massage therapist child and parent are in the room* Appropriate draping will be used at all times during the massage only areas being massaged are uncovered* I am the parent/legal guardian of give permission for my child age to receive massage therapy from Staci Williams. In collaboration with the consenting adult and child the massage therapist will assist in establishing goals for the session s. For clients age 15 and under the parent/guardian must always be present in the treatment room* comfortable with the child being in the session room by themselves please initial here. For clients age 15 and under the parent/guardian must always be present in the treatment room* comfortable with the child being in the session room by themselves please initial here. Otherwise parent/guardian should be in the treatment room during each session* Once a comfortable therapeutic relationship has been established and the massage therapist child and parent are in the room* Appropriate draping will be used at all times during the massage only areas being massaged are uncovered* I am the parent/legal guardian of give permission for my child age to receive massage therapy from Staci Williams. In collaboration with the consenting adult and child the massage therapist will assist in establishing goals for the session s. For clients age 15 and under the parent/guardian must always be present in the treatment room* comfortable with the child being in the session room by themselves please initial here. Otherwise parent/guardian should be in the treatment room during each session* Once a comfortable therapeutic relationship has been established and the massage therapist child and parent are in the room* Appropriate draping will be used at all times during the massage only areas being massaged are uncovered* I am the parent/legal guardian of give permission for my child age to receive massage therapy from Staci Williams. .

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