Leolionbeauty lash extensions, lift & tint, & brow lamination Consent Form
Lash and Brow studio
Client Information
Name
*
First Name
Last Name
Age
*
Date of Birth
*
-
Month
-
Day
Year
Date
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
City
State / Province
Postal / Zip Code
Emergency Contact Details
**only fill out if between the ages of 16 - 18**
If you are a minor, in case of emergency, we will contact the person below:
Emergency Contact Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Relationship
Signature of parent or guardian if between the ages of 16 - 18
Please sign here
Previous lash & brow experience
Do you have any allergies to Latex?
*
If yes, please specify on the field above.
Do you have any allergies to banana's, kiwi's, strawberries, polish remover, nail polish, or Nuts?
*
If yes, please specify on the field above.
Do you usually rub, pull, or pick your lashes/eyebrow hair?
*
If yes, please specify on the field above.
Do you have eczema and/or dermatitis around your eye, under eye or eyebrow area?
*
If yes, please specify on the field above.
Have you ever had previous irritations to lash extensions?
*
If yes, please specify on the field above.
How did you hear about me?
Reason for switching Lash artists?
If yes, please specify on the field above.
Any concerns you have regarding lash extensions, lash lift & tints, brow lamination, or henna brows that I should be aware of? IE: Do you wear contacts/glasses, etc.
*
If yes, please specify on the field above.
Consent and Waiver
*
I certify that I have read this entire informed consent and I understand and agree to the information provided in the form. My questions regarding lashes and eyebrows have been answered. I hereby release Leolionbeauty and Caitlin deSousa from all liabilities associated with lash extensions, lash lifts, eyebrow laminations and henna eyebrows.
I give permission to Leolionbeauty to use any photos taken for Instagram and/or promotional events.
I acknowledge that all information I provided in this form is true and accurate.
I acknowledge that I am coming to this appointment at my own risk. Leolionbeauty is taking all necessary precautions regarding COVID-19 sanitary stipulations and will not be held liable for any COVID-19 related illness's .
I have read through Leolionbeauty's Policy page on the website and understand all the policies to the best of your abilities.
Signature of the Client
*
Please sign here
Date Signed
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: