Windows of Wellness Membership Agreement

Minor Consent Form
By signing below I herby authorize Windows of Wellness and their certified massage therapy staff to administer massage therapy as deemed necessary to my son/daughter.
Name of Child *

First Name Last Name
I also approve of any future treatment sessions.
Date *

Month Day Year
Name of Parent/Guardian *

First Name Last Name
Signature *

Clear
Windows of Wellness Massage Therapy, Inc.
142 W. Lakeview Avenue, Suite 1040
Lake Mary, FL 32746
info@windows-wellness.com
www.windows-wellness.com
(407) 415 - 5429
Should be Empty:

Minor Consent Form