Parental Consent Form

This form must be signed in person by the parent or guardian at the time of service and witnessed by the esthetician.

As the parent or legal guardian of:

I confirm that I have read and understand all information on the applicable forms for this treatment or service, and accept responsibility on my child’s behalf for any disclosures or liability described on those forms. I agree to supervise any home care procedures that are recommended as a result of the treatment.

Signature of Parent/Guardian: (In Person at time of treatment) __________________________________

Signature of Esthetician: (In Person at time of treatment) __________________________________