To ensure that clients are able to give Informed Consent as they register at NormQuantz.com a copy of our Consent of Parent/Guardian is available here for you to download and/or print to read at your convenience. We want you to fully understand the contract you are entering into and if you have any questions regarding either the content or meaning of any of the forms please ask your questions using the Contact Norm page. We will be happy to fully explain anything that is unclear or concerns you.
You will need to Print Form below. Please complete it and fax to 1-877-221-9808
Parental/Guardian Consent and Agreement Form
Parent/Guardian Name: _________________________________________
Address: _______________________________________
City: _______________________ Prov/State: ________
Country ___________________ Zip _______________
Phone Number ___________________________________
We will be calling you (the parent or guardian) to set up a short web-conference, which will be recorded. We will save a digital copy of your audio-video consent and agreement on behalf of the minor endorsed below. Your consent and agreement will remain in force and valid until withdrawn by notice in writing, subject to our Terms of Use. Should further consulting be warranted and desired, and the person named below still not be of the age of majority, this consent and agreement will require renewal by you, using the process we have in place at the time of such renewal.
This Consent and Agreement includes and incorporates our Terms of Use and refers to our Privacy Policy and you confirm that you have read and understood both.
Parent Guardian
Name of minor for whom you are giving consent. __________________________
Date of Birth of the Minor ___ (mm) ____(dd) ____(yyyy) Gender of the Minor M F
You give your consent and agree on behalf of the above named minor to enter into relationship-makeover consultations with a Norm Quantz, MA and access the secure website of myrelationship-makeover.com. You further agree that you have fully read and accept the practices described in our Privacy Policy with respect to personal information and that you have fully read and agree to all the terms and conditions in our Terms of Use and that you will fulfill all the financial obligations to us on behalf of the above name minor.
I warrant and represent that I have read, accept and agree to the above terms and conditions of this
Parent/Guardian Signature: ________________________ Date: _______________________
You will need to Print Form above. Please complete it and fax to 1-877-221-9808
