Non-Guardian Permission

Non-Guardian Permission
I, First Name* Last Name, am the parent or legal guardian of First Name* Last Name*.
As a parent or legal guardian, I give consent forFirst Name* Last Name* to:
(check all that apply)*

Book/confirm appointmentsCancel appointmentsPay for appointmentsSit in session
I,First Name* Last Name*, understand and agree that I can withdraw my consent at any time. The information I've given is complete and accurate. By signing this form on Date* , I confirm that I have fully informed myself of the contents of this Non-Guardian Permission Form by reading it before I signed it.

First Name* Last Name*
Client Signature*

Clear
Should be Empty: