Art Therapy Informed Consent for Minors
Minor's Information
Full Name
Date of Birth
Address
Parent/Guardian Information
Full Name
Relationship to Minor
Contact Number
Therapist Information
Therapist Name
Therapist Credentials
Purpose of Art Therapy
Potential Benefits & Risks
Confidentiality
Consent for Participation
Parent/Guardian Signature
Printed Name
Date
Therapist Signature
Printed Name
Date