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 NameLast Name

Emergency contact Phone Number*

Area CodePhone 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?*

YesNo

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

Does the child have any allergies?*

YesNo

If so, please list them

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

YesNo

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?*

YesNo

If so, please describe

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

YesNo

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 consentI do not consent

All appointments are booked with a 50% non refundable deposit. If a deposit is not taken while booking your follow up appointment, your account will automatically be charged 1 week before your appointment. If the deposit is not collected, your appointment may be cancelled.

I understand and agree

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. 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.

Appointments canceled within 48 hours or less of the scheduled time will incur a fee equal to 50% of the service rate. Missed consultations will be charged the full price, $10. All appointments are booked with 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