This form is for clients ages 10–17. A parent/legal guardian must complete this form before services are provided.
1) Parent/Guardian Consent
I, [Parent/Legal Guardian Full Name], am the parent/legal guardian of [Minor Full Name] (DOB: [DOB]). I give permission for No More Knots Massage to provide massage therapy services to my child.
2) Parent/Guardian Presence
I understand a parent/legal guardian is not required to be present in the treatment room during the session; however, if the parent/legal guardian wishes to remain in the room, it is allowed. The parent/guardian MUST BE ON PREMISE, for the entire duration.
3) Health & Medical Information
I confirm I have disclosed any relevant medical conditions, injuries, surgeries, allergies, medications, and other health concerns for the minor. I agree to update this information before each appointment.
4) Consent to Touch, Draping & Boundaries
I understand massage therapy involves professional, non-sexual touch. Proper draping will be used at all times, and only the area being worked on will be uncovered. The minor may request adjustments, request that any area not be worked on, or request to stop the session at any time.
5) Scope of Practice
I understand massage therapy is not a substitute for medical care, diagnosis, or treatment.
6) Cancellation / No-Show / Refund Policy (Applies to Minor Appointments)
More than 72 hours’ notice: 50% of the service price will be refunded (a 50% cancellation fee applies).
72 hours or less notice (including less than 24 hours): no refund (may be charged 100% of the service fee).
No-shows/unreachable: treated as 72 hours or less notice.
No parent/guardian on premise treated at a no show.
7) Acknowledgment & Release
I acknowledge that massage therapy may involve risks (including temporary soreness or discomfort). To the extent permitted by law, I release and hold harmless No More Knots Massage and its therapists from liability for any injury or adverse outcome related to the minor’s massage session, except in cases of gross negligence or willful misconduct.