Reiki Consent form (Under 16s)-ReikiEma

Reiki Consent form (Under 16s)

Parental/Guardian permission form for Under 16s to receive Reiki. *Note* This form only needs to be completed before the first Reiki session with Ema, OR if any of the details change, so that our records remain up to date and correct.

First Name

Last Name

Phone Number

Name of young person to receive Reiki

Write a short comment

Your relationship to the young person

Address

Consent Statement

(this is the legal part)

I understand that as parent/guardian of the young person named above, I may be committing a

criminal offence if I fail to provide adequate medical aid for a child under 16 years of age, in my care.

I have been informed by Ema Melanaphy (Reiki Practitioner) that according to UK Law I must consult a Doctor regarding any matters relating to the health of my child.

I have read and understand the above, and give permission for the Reiki session(s) to proceed.

Your Signature

Date