Youth Camp Facial Consent
Please complete this form to provide camper details, share any skin sensitivity or care instructions, and authorize participation in the facial activity at camp.
Camper and Parent/Guardian Information
Camper Full Name
*
First Name
Middle Name
Last Name
Date of Birth
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age
Camp Session
*
Please Select
Session 1
Session 2
Session 3
Family Camp
Other
Parent/Guardian Full Name
*
First Name
Middle Name
Last Name
Relationship to Camper
*
Please Select
Parent
Guardian
Grandparent
Foster Parent
Other
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Facial Consent Details
Specific Facial Service or Activity
*
Basic Facial
Moisturizing Facial
Cleansing Facial
Acne Care Facial
Facial Massage
Other
Skin Sensitivity or Known Allergies to Facial Products or Treatments
*
Yes
No
If Yes, Please Describe the Sensitivity or Allergy
Recent Skin Issues That May Affect Participation
Acknowledgment of Camp Safety Adjustments
*
I understand the camp may stop, pause, or modify the facial activity if needed for safety or comfort
Health and Care Instructions
Relevant Medical Considerations
Product Restrictions or Ingredients to Avoid
Preferred Aftercare Instructions
Emergency Contact Name and Phone
Consent and Signature
I approve my camper’s participation in the facial activity and authorize the camp to proceed with reasonable modifications if needed
*
I agree
Parent/Guardian Signature
*
Date Signed
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Submit
Should be Empty: