Minor: Consent and Acknowledgment

Consent and Acknowledgment
I hereby consent to and authorize Sevierville Massage Therapy and it's employees to perform massage therapy and/or wellness/stretching services on my minor child.*

Parent/Guardian's First NameLast Name
Minor's Name*

First NameLast Name
Health Information: Does the minor have any medical conditions, injuries, or allergies that we should be aware of? If yes, please describe:
I understand the following:

Purpose of Massage Therapy/wellness/stretching: The massage or other services are intended to promote relaxation, stress relief, muscular recovery or address specific muscular concerns.

Voluntary Participation: My child may choose to discontinue the session at any time.

Scope of Practice: Massage therapists do not diagnose or treat medical conditions and are not a substitute for medical care.

Appropriate Draping: My child will remain appropriately draped at all times.

Privacy: A parent/guardian has the right to remain in the room during the session.
Release of Liability: I release and hold harmless Sevierville Massage Therapy and it's therapists/employess from any claims or liabilities arising from any service. Signature: By signing below, I certify that I am the legal parent/guardian of the minor named above and have the authority to provide this consent. Parent/Guardian Signature:*

Clear
Date*

MonthDayYear
Date
Phone number in case of emergency*
Please enter a valid phone number.
Should be Empty: