Luxury Lash Lounge COVID-19 Liability Release Waiver

We ask that our clients disclose their health history and continue to implement these sanitation and disinfection procedures.Symptoms of COVID-19 include:

Fever
Fatique
Dry Cough
Difficulty Breathing

I agree to the following:*

I, nor members of my household, have not experienced any of the symptoms listed above within the last 14 days.I, nor members of my household, have not travelled internationally in the last 30 days.I, nor members of my household, do not believe that we have been exposed to someone with a suspected and/or confirmed case of the Coronavirus (COVID-19).I, nor members of my household, have not been diagnosed with the Coronavirus (COVID-19) within the last 30 days.Luxury Lash Lounge cannot be held liable from any exposure to the Coronavirus (COVID-19) caused by misinformation on this form or the health history provided by each client.If I take any steps to make a claim for damages against Luxury Lash Lounge , its agents, employees or any other released parties, I shall be obligated to pay all of my own and Luxury Lash Lounge’s attorney’s fees and costs incurred as a result of such claim

Luxury Lash Lounge is following these enhanced procedures to prevent the spread of the Coronavirus (COVID-19)

-All clients must wear a mask upon entry of our studio

-We are enforcing a strict no guest policy

-We encourage clients to bring their own blanket if they wish to use one during their service as we will no longer be providing blankets

-Additional time will be scheduled in between client appointments to limit client contact.

-Each client is required to wash their hands upon arrival and before departure.

-Lash technicians will throughly disinfect their hands before and after every service

-All equipment used during treatment will be cleaned, sterilized, and disinfected

-All surfaces will be thoroughly cleaned with hospital grade disinfectant before and after each client, according to the manufacturer’s directions.

By signing below, I hereby release and agree to hold Luxury Lash Lounge harmless from and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses, and compensation for damages or loss to myself and/or property that may be caused by any act, or failure to act of the salon, or that may otherwise arise in any way in connection with any services received from Luxury Lash Lounge. I agree to release Luxury Lash Lounge from any and all liability for the unintentional exposure or harm due to the Coronavirus (COVID-19)

Date*

Date

Name*

First NameLast Name

Phone Number

Signature*

Have you ever had lash extensions applied before?

YesNo

Are you being treated for an eye illness or injury (past 6 months)?

YesNo

I understand that there are risks associated with having artificial eyelashes applied to and/or removed from my natural lashes.*

Yes

I understand that the fumes from the adhesive may cause my eyes to water if I open my eyes.*

Yes

I understand that as part of the procedure eye irritation, pain, itching, discomfort and in rare cases eye infection may occur.*

Yes

I understand and agree that if I experience any of these issues with my lashes I will contact my technician and have the eyelash extensions removed immediately and consult a physician at my own expense.*

Yes

I understand and agree to follow the aftercare instructions provided by my technician. Failure to follow the aftercare instructions may cause the eyelash extensions to fall out.*

Yes

I understand that in order to have the eyelash extensions applied to my eyelashes I will need to keep my eyes closed for a duration of 60-180 minutes during the procedure. Failure to do so can result in burning or eye irritation, which can lead to infection, or chemical burn from the glue. *

Yes

I acknowledge and understand that the studio doesn’t do Refunds.*

Yes

I understand that eyelash extensions require ongoing maintenance ( similar to a nail service). Refills are recommended approx. every 2 to 4 weeks. I understand if I go beyond this recommended time it may need a full set or incure a higher 'relash' price.*

Yes

I release my certified lash technician and Luxury Lash Lounge from any and all liability associated with this procedure. This service will be performed with the utmost attention to safety, sanitation and proper application using tools and products that the technician has been trained and certified to use. This service has many variables due to lifestyle, moisture, weather, extreme tempatures, natural eyelash shedding and other factors. The technician ( along with my consent form and consultation) will decided if I am a good candidate for this service to the best of their ability.*

Yes

Checkmark if you have any of the following conditions:

Current use of eye drops of any kind, prescription or over-the-counterCurrent allergies or sensitivitiesHistory of recurrent eye or tear duct infectionsHistory of dry eyes or Sjorgen`s SyndromeRecent history of Chemotherapy

Checkmark to agree to the following eyelash extension follow-up and maintenance instructions:*

No waterproof mascaraNo oil based products around the eye areaNo water can come in contact with the eye area for 24 hours after the applicationNo tinting or perming of eyelash extensionsNo pulling or rubbing of the eyelash extensions

I grant permission to use my before and after photos for marketing or examples of my technicians work.

YesNo

By signing below, I here by release and agree to hold Luxury Lash Lounge harmless from and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses, and compensation for damages or loss to myself and/or property that may be caused by any act, or failure to act of the salon, or that may otherwise arise in any way in connection with any services received from Luxury Lash Lounge. If I take any steps to make a claim for damages against Luxury Lash Lounge , its agents, employees or any other released parties, I shall be obligated to pay all of my own and Luxury Lash Lounge’s attorney’s fees and costs incurred as a result of such claim.*

YES

By signing below, I verify that I have read and understand the above statements and agree to them. Thank you for the time you took to read, understand and agree to our consent form.*

Yes

Signature

COVID-19 QUESTIONAIRE & LIABILITY WAIVER

EYELASH EXTENSION CONSENT FORM & LIABILITY WAIVER