Date:___________________
Model Shop Name: _____________________________________________
Address:______________________________________________________
City: ___________________ State: ______ Zip: _______________-_______
Name Of Minor: ________________________________________________
_______________________________________ Date: __________________
Signature Of Minor
I attest that I am the parent or legal guardian of the above named minor. I
further, give
my written consent for the application of this process, known as the "Suddenly
Slender
The Body Wrap"™ to _____________________________________, a minor
who
I am the legal guardian, or parent of. It is understood that this process has
been fully
explained to me as an inorganic mineral body wrap that is used as a beautifying
service
to visually slenderize the body.
By my signature below I grant this location permission to utilize this system
on the
above identified minor.
Consenting Adults Name: ___________________________________________
_________________________________ Date:_________________________
Signature of Parent or Legal Guardian