It is an honor to work with the teens in our community.  

Parents:  Please fill out this waiver and we will receive it immediatly. 

Note: We can take your teen with your permission, if your teen is already at the office with this waiver filled out by you.  Thank you!

PARENT CONSENT / MINOR RELEASE WAIVER

All persons under the age of 18 are required to have a parent or guardian fill out this disclaimer form. By signing below, you are stating that you are the parent or legal guardian of the minor receiving treatment(s) at our facility. You are welcome to stay in the clinic/treatment room with your minor the entire time or you can also check the box below to give your minor permission to walk over or be dropped off at the clinic. The services at the Clinic are not substitutes for medical advice or physician-prescribed treatment.

By clicking the boxes below, you understand the following:

You certify that you are the parent/legal guardian of the minor indicated below.  You understand the scope of our holistic services and counseling and that it is not meant to diagnose, treat, or cure any conditions and is not a replacement for standard medical care. You give permission for you minor child to receive treatment(s) at this facility and agree to all the above terms by clicking the box below.

This consent / minor release waver includes the Community Drop-In Holistic Clinic and Private Sessions and gives the Holistic Practitioner's working at the clinic permission to support your minor child.

Click here for a printable Parent Consent / Minor Release Form

Drop-In Holistic Community Clinic:

Our Drop-In Holistic Clinic is not private.  There will be several practitioners and clients giving and receiving treatments in the same room.

Private Sessions?

If you schedule a private session for your child/teen, then the session can be private or parents can stay in the room with your child/teen.

Practitioners

All practitioners are independant contractors and not employees of the Alternative Healing Center.  This waiver covers all of the practitioners working under the umbrella of the Alternative Healing Center.

Parents: Please fill out the entire waiver.

Thank you!