Children’s Intake form

Child's Name: *

Child’s Date of Birth: *

Date

Parent/caregiver’s Name: *

Relationship to the child: *

Telephone: *

Email: *

example@example.com

Emergency contact: *

First Name Last Name

Emergency contact Phone Number *

Area Code Phone Number

Emergency contact’s relationship to the client: *

How did you hear about us? Facebook, Instagram, Web search, Other

Is the child’s hair 100% natural? *

Yes No

If not, when was their last relaxer/chemica process?

Does the child have any allergies? *

Yes No

If so, please list them

Is the child taking any medications or have health issues that we should be aware of? *

Yes No

If so, please list them

Please name some products that are used at home?

Does the child have a sensitive scalp, itching, dryness, breakage, or hair loss? *

Yes No

If so, please describe

Has the child worn tight braids or any extensions recently? *

Yes No

What are some hair goals for your child?

We photograph and record our work throughout the salon for promotional, public relations activities, and social media. We typically do not use names only photos and videos. All photographs and recordings are property of Taji Natural Hair Styling.

I consent I do not consent

We look forward to working with all of our young client's to help them expand the love they have for their amazing natural hair!!
****Please be aware that while the child is receiving services at Taji Salon we require parents and caregivers to remain in the waiting area (post covid-19), and in their car (during covid-19). This allows our Natural Hair Care Practitioners to provide the best possible and efficient service to the child. Please remain in the vicinity for the duration of the child’s appointment. We reserve the right to refuse services if the child becomes disruptive to the atmosphere of the salon or stylist. It is my choice to receive natural hair care services for this child. I have completed this form to the best of my knowledge. I have stated all medical conditions that I am aware of and I will update Taji Salon of any changes to the child’s health status. I understand that Natural Hair Care Practitioners do not diagnose illness, disease, or physical disorders, nor do they prescribe medical treatments, or pharmaceuticals. If I am unable to make a scheduled appointment, I agree to cancel the appointment 24/48 hours in advance by phone. If I miss a scheduled appointment without giving 24/48 hour notice, I agree that my credit card can be charged for the missed appointment fee that applies. Specialty services such as extensions or services that exceed 3 hours will require a 48 hour cancellation window and a non refundable deposit.*If you are not satisfied with the child’s style in any way, let your stylist know before you leave. We will do our best to adjust the style in any way, or we will remove the style for you if time permits. After this time you may not be eligible for a style re-do or any sort of refund. If you are not satisfied with the customer service please let us know within the time of your visit. We are not responsible for missing or damaged property while in the salon. Please keep your belongings with you.

Date: *

Date

Signature

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