Client Policy Agreement Form

Client Policy Agreement Form

Please review and acknowledge our policies by checking the boxes, signing, and dating below. Complete both sections as required.
Child/Client Name

First NameLast Name
Policy Acknowledgment - Section 1

Please read each statement and confirm your agreement.
I have read and agree to the Privacy Policy.
I have read and agree to the Terms of Service.
Signature (Section 1)
Name of Parent/Representative signing
Date (Section 1)

MonthDayYear
Date
Policy Acknowledgment - Section 2

Please review any additional policies and confirm your agreement.
I have read and agree to the Refund Policy.
I have read and agree to the Code of Conduct.
Signature (Section 2)
Name of Parent/Representative signing
Date (Section 2)

MonthDayYear
Date
Should be Empty: