parent/legal guardian consent form PLEASE NOTE: This online form must be filled out and submitted by a parent or legal guardian prior to the time of service. A parent or legal guardian must be physically present with the minor for the duration of the service. Today's Date * MM DD YYYY Parent/legal guardian name * First Name Last Name Email * Phone * (###) ### #### Name of minor receiving service at eleven esthetics * First Name Last Name Minor's preferred pronoun(s) * Minor's birthdate * MM DD YYYY Date of scheduled service at eleven esthetics * MM DD YYYY CONSENT FOR TREATMENT/SERVICE * As the parent or legal guardian of the above-named minor, I give permission for her/him/them to have the scheduled treatment/service at eleven esthetics. I confirm that I understand all information regarding this treatment/service, and accept responsibility on the minor's behalf for any disclosures or liability described on all forms sent separately. I agree to supervise any home care procedures that are recommended as a result of the treatment. Yes No By checking the box below and submitting the contents of this form via the 'send' button, I agree to the terms of this Parent/Legal Guardian Consent form. * NOTE: This checkbox is equivalent to electronic consent & a legally binding agreement. Thank you!
