MINOR CONSENT FORM

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MINOR CONSENT FORM

The information being collected on this form will only be used for the purpose of parental consent for any client who is under the age of 18 and wishing to have the treatment, specified below, at Pure Skincare & Acne Spa. Please complete the details below prior to treatment. Thank you!

First and Last Name of Minor: *

I give consent for my minor child to receive the following treatment/s: *

Parent/ Legal Guardian's Name: *

First and Last

Parent/ Legal Guardian's Phone Number: *

Including Area Code

Relationship to Minor: *

As the parent/ legal guardian, I am happy to give my consent for the minor listed above to have the specified treatment/s. I have filled out the client consent form and can confirm all the information provided is correct. Should I have any questions or concerns, I will address them with the service provider prior to any appointments: *

PLEASE TYPE YOUR FULL NAME IN ALL CAPITAL LETTERS TO INDICATE YOUR SIGNATURE:

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