As the parent or legal guardian of Name of Minor (Minor's Name), I give permission for her/him to have the following services performed: Services being performed I confirm that I have read and understand all information on the applicable forms for this treatment or service, and accept responsibility on my child's behalf for any disclosures or liability described on those forms. I agree to supervise any home care procedures that are recommended as a result of the treatment.Date Full Name of Parent or guardian:First Name Last Name Signature of parent or guardian:Signature ***This Form must be signed in person by the parent or guardian at the time of service, witnessed by the esthetician.