Windows of Wellness Membership Agreement

Minor Consent Form
By signing below I herby authorize Windows of Wellness and their certified massage therapy staff to administer massage therapy as deemed necessary to my son/daughter.
Name of Child*

First NameLast Name
I also approve of any future treatment sessions.
Date*

MonthDayYear
Name of Parent/Guardian*

First NameLast Name
Signature*

Clear
Windows of Wellness Massage Therapy, Inc.
142 W. Lakeview Avenue, Suite 1040
Lake Mary, FL 32746
info@windows-wellness.com
www.windows-wellness.com
(407) 415 - 5429
Should be Empty:

Minor Consent Form