Consent to Treat* As the parent or legal guardian with the authority to consent on behalf of the minor child listed below. I hereby give my consent for iCare Health & Wellness and its affiliates to provide counseling/recreational play therapy to my child.
First Aid Authorization* I authorize iCare Health & Wellness to administer first aid to my child in the event of an emergency
Permission to Publish*I authorize iCare Health & Wellness to collect photography and or videography for advertisement and promotional use only
Transportation Agreement* I authorize iCare Health & Wellness to transport my child within the Greater Columbus Area
I/We (Parent/Guardian) , am the parent or legal guardian of (child’s name) , a minor, whose date of birth is . I nearby authorize iCareOhio Wellness Group and it’s affiliates to provide counseling and or recreational play therapy to my child. blanks*blank*