Minor Release Form

1

Minor's Name

First Name

Last Name

2

Minor's Birthday

Date

3

Parent/Guardian's Name

First Name

Last Name

4

Parent/Guardian's Phone Number

Please enter a valid phone number.

5

I First Name Last Name certify that I am the responsible parent/guardian for First Name Last Name .

For clients aged 13 and under: we REQUIRE the parent/guardian to remain in the room during the service. If you'd like to waive this requirement, please initial here Signature

For clients aged 14-17: we RECOMMEND the parent/guardian remain in the room during the service.

You have completed the Intake and Consent Form on behalf of the minor and have informed the esthetician of all medical diagnoses, symptoms, medications, allergies, and concerns associated with the minor receiving service(s).

By signing below, you agree to these terms, and have identified that you are the parent or legal guardian of the minor receiving service(s) at Skin Society Hawaii. If you have any questions, please reach out to us as soon as possible.

6

Signature

Clear