Minor Consent Form

Minor Consent Form

Parent and/or guardian consent to treat his or her minor child with services within Baree Essence for a given amount of time.
Parent's Name

First NameLast Name
Minor Child's Name

First NameLast Name
Minor Child's Birth Date

MonthDayYear
Parent's Phone Number

Area CodePhone Number
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.

By signing this form, you certify that you are the parent or legal guardian of the child receiving the
treatments. You acknowledge that you are aware of the health risk inherent in any form of hands on
services provided from any like kind of medical, massage, facials, waxing, or makeup services that
your child will be receiving, and waive any and all claims to damages or injuries that you or your
child may have against Baree Essence.
Today's Date

MonthDayYear
Date
Parent Signature
Thank you for your time and business. Have a wonderful day and enjoy your massage.
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