Parental/Guardian Consent and Minor Assent for Strength Training and Sports Massage (Texas)

1

Is the athlete a minor (under the age of 18)* This field is required.

Yes

2

Minor Full Name* This field is required.

Minor first name

Minor last name

3

Date of Birth* This field is required.

Date

4

Age* This field is required.

5

Gender* This field is required.

6

Primary sport or activity

7

Parent/Guardian Name* This field is required.

Parent/Guardian first name

Parent/Guardian middle name

Parent/Guardian last name

8

Parent/Guardian Phone Number* This field is required.

Please enter a valid phone number.

9

Parent/Guardian Email Address* This field is required.

Enter the parent or guardian email address where we can send updates or questions.

10

Relationship to Minor / Child* This field is required.

Select the person who is the child’s parent, guardian, or primary family contact.

11

Physician name* This field is required.

Enter the name of the physician or medical provider who should be contacted if needed.

12

Physician Phone Number* This field is required.

Please enter a valid phone number.

13

Current injuries or conditions * This field is required.

Describe any current injuries, chronic conditions, or concerns that may affect participation.

14

Recent surgeries or procedures in the last 12 months* This field is required.

Yes

No

15

If yes, describe recent surgeries or procedures in the last 12 months* This field is required.

If yes, briefly describe the surgery or procedure, including approximate date if known.

16

Skin conditions, allergies, or sensitivities* This field is required.

Yes

No

17

If yes, describe skin conditions, allergies, or sensitivities* This field is required.

If yes, describe the skin concern, allergy, or sensitivity in a few words.

18

Recent or relevant injuries* This field is required.

List any recent injuries, pain, or issues that the provider should know about.

19

Current medications* This field is required.

List all medications the minor is currently taking, including over-the-counter medicines if relevant.

20

Emergency Contact Name* This field is required.

Emergency contact first name

Emergency contact middle name

Emergency contact last name

21

Emergency Contact Phone Number* This field is required.

Please enter a valid phone number.

22

Clients UNDER age 16: Will a parent or guardian remain present during the session?* This field is required.

I will remain present on the premises during the session

I will NOT be present during the session / I am dropping my child off

23

Clients ages 16-17: I acknowledge and consent to my child attending without me present.* This field is required.

I acknowledge and consent to my child attending without me present.

My child is not age 16-17

24

Best number to reach you during this session* This field is required.

Please enter a valid phone number.

25

SEKMET STRENGTH & RECOVERY Minor Client Waiver, Parental Consent & Informed Consent Form

Services Covered: Sports Massage Therapy, Soft Tissue Work, Strength Coaching

Description of Services

Sekmet Strength & Recovery provides sports massage therapy, soft tissue and fascial work, and strength-based coaching services. These services are designed to support athletic performance, recovery, and injury prevention. Sessions may include manual techniques applied to soft tissue, assisted stretching, movement assessment, and guided strength training.

Acknowledgment of Minor Status

I, the undersigned parent or legal guardian of the minor named in this form, hereby provide my informed consent for my child to receive services at Sekmet Strength & Recovery. I confirm that I am the legal parent or guardian of this minor and have the legal authority to provide this consent.

Parental / Guardian Supervision Policy

For clients under the age of 16, a parent or legal guardian must be present on the premises for the duration of each session. For clients ages 16–17, a parent or guardian may drop off the minor client with prior written approval from Sekmet Strength & Recovery. Regardless of age, the parent or guardian remains the responsible party and primary point of contact.

Health Disclosure & Medical Clearance

I confirm that the health information provided in this form is accurate and complete to the best of my knowledge. I understand that it is my responsibility to inform Sekmet Strength & Recovery of any changes to my child's health status prior to each session. I acknowledge that sports massage, soft tissue therapy, and strength coaching are not substitutes for medical diagnosis or treatment. If my child has a condition that may be affected by these services, I have consulted or will consult a licensed physician prior to beginning services.

Assumption of Risk

I understand that sports massage, soft tissue work, and strength coaching involve physical contact and physical exertion, and that these activities carry inherent risks including but not limited to: temporary muscle soreness, bruising, fatigue, or aggravation of a pre-existing condition. I voluntarily consent to these services on behalf of my minor child with full awareness of these risks.

Release of Liability

To the fullest extent permitted by Texas law, I, as parent or legal guardian, hereby release, waive, and discharge Sekmet Strength & Recovery, its owner, employees, and contractors from any and all claims, demands, or causes of action arising out of or related to the services provided to my minor child, including claims arising from negligence, except in cases of gross negligence or willful misconduct.

26

As the parent/guardian, I have read, understood, and agree to the terms and conditions of the SEKMET STRENGTH & RECOVERY Minor Client Waiver, Parental Consent & Informed Consent Form* This field is required.

Yes, I have read, understood, and agree to the terms and conditions of the SEKMET STRENGTH & RECOVERY Minor Client Waiver, Parental Consent & Informed Consent Form

27

Parent/Guardian Name for Signature* This field is required.

Parent/Guardian first name

Parent/Guardian last name

28

Parent/Guardian Electronic Signature* This field is required.