Minor Client Consent Addendum
This addendum is completed for all clients under the age of 18. It supplements the Client Consent and Release of Information Form and the Client Funding Agreement and clarifies the guardian's role and the transition process when a minor client approaches the age of 18.
Minor Client Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Parent / Legal Guardian Name
*
First Name
Last Name
Relationship to Client
*
Guardian Role and Communication
All formal communication regarding funding, billing, and coordination will be directed to the parent or legal guardian listed above unless otherwise indicated. The minor client will not receive funding-related communications directly from Paperflower Foundation without guardian consent.
May we communicate directly with the minor client about non-financial matters such as appointment reminders?
*
Yes
No
Only if the guardian is copied
Preferred method for appointment-related communication with the minor client (if applicable)
Approaching Age 18
If the minor client will turn 18 during their funding period Paperflower Foundation will contact the guardian approximately sixty (60) days before the client's 18th birthday to discuss transition. At that point the client will be required to sign their own consent and funding documents as an adult. Funding will not automatically lapse at age 18 but a transition process must be completed before the next funding period begins.
Client's 18th birthday (if within the current or next funding period)
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Month
-
Day
Year
Date
Age Status During Funding Period
*
Client will turn 18 during this funding period — transition planning needed
Client WILL NOT turn 18 during this funding period — no immediate action required
Legal Authority
Is the signing guardian the sole legal guardian of this minor?
*
Yes
No — there is a co-parent or co-guardian who also has legal authority
If NO — does the co-parent or co-guardian need to sign Foundation documents?
*
No — I have sole legal authority to consent on behalf of this child
Yes — co-guardian signature will be obtained
There is a court order limiting the other party's authority — with documentation attached
Please attach the documentation here:
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Signature
By signing below the guardian confirms they have the legal authority to consent on behalf of the minor client named above and that all information provided is accurate.
Guardian Printed Name
*
Guardian Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit
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