Minor Release Form printable pdf download

MINOR RELEASE FORM

(Under Age 18)

Here at Heavenly Touch Massage, we believe that everyone can benefit from receiving massages

even children. What better way to teach your child the importance of caring for itself in a healthy

and relaxing manner? They will receive the same quality service and respect with a few minor

modifications to accommodate your child.

All persons under the age of 18 must have a parent or legal guardian fill out the Health Release

Form below. We ask that you remain at Heavenly Touch Massage Center for the duration of the

services. If you minor is under age 15 we encourage you to wait in our office or in the room with the

minor that will be receiving our services.

You will be asked to help escort the minor to the massage room and if needed to assist them in

preparing for the massage therapy. Please complete the following Child Service Waiver. Make

sure you have signed and dated both the Client Intake Form and this Minor Release Form.

By signing this form, you certify that you are the parent or legal guardian of the child receiving the

massage therapy services. You acknowledge that you are aware of the health risk inherent in

any form of hands on services provided from any like kind of medical or massage services that your

child will be receiving, and waive any and all claims to damages or injuries that you or your child

may have against Heavenly Touch Massage or any of the registered therapist that may be used by

Heavenly Touch Massage. By signing below you agree that you have read, understand and agree

to this statement, "I am giving up certain legal rights and / or remedies."

PLEASE PRINT CLEARLY:

I ___________________________________________, certify that I am a parent or legal guardian of

____________________________________________, who is ____________ years of age as of today.

I grant permission for my minor child to receive the selected service from Heavenly Touch Massage

mentioned above. I have accurately filled out the Client Intake Form for the minor that is going to

be receiving the massage therapy services today and if need be for any future dates with

Heavenly Touch Massage. I am aware of the legal waiver that is in full effect with this signature

for the person receiving the services as well as myself.

SIGNATURE OF PARENT or LEGAL GUARDIAN

____________________________________________ Signature

____________________________________________ Print Name

____________________________________________ Date

If for any reason that you become non-eligible for the signing of this document for future dates

you will submit in writing to Heavenly Touch Massage that information by a written letter either

in person to Heavenly Touch Massage or by Certified Mail.

Minor Release Form