Service Consent Form

Name *

First NameLast Name

Phone Number *

Email *

example@example.com

How did you hear about Nautiwax:*

i.e: Google, friend, if friend - please provide name, etc.

Are you at least 18 years old? Guests under 18 must have consent granted by a parent or legal guardian.*

YesNo

Birthday*

Date

Parent or legal guardian*

First NameLast Name

Parent or legal guardian phone *

Area CodePhone Number

Parent or legal guardian email*

example@example.com

Have you used any Alpha Hydroxy Acid (AHA) or glycolic products in the past 48-72 hours?*

YesNo

Are you using Retin-a, Retinol, Retinoic Acid, or Hydroquinone?*

YesNo

Are you using, or have used in the lasty year, Accutane, Roaccutane, or Isotretinoin?*

YesNo

Are you using any steriods or antibiotics?*

YesNo

Are you using any other potentially skin thinning products and/or drugs?*

YesNo

Are you taking any medications that can affect skin condition? If so, please list all:

Communicate to your waxer if you:

- Have Lupus.
- Are receiving chemotherapy and or radiation treatment.
- Have been in direct sunlight for an extended time.
- Have used a tanning bed within the last 24 hours.

POLICY:

Cancellation and Late arrival. Nautiwax permits clients to cancel their own appt if it is greater than 24 hours out. Cancellations within 24 hours of the appt require a 35% charge. No shows (no call) will be charged a 50% cancellation fee. Late arrivals of 10 minutes or more may require rescheduling which results in a 35% service charge, call Nautiwax to check the days schedule. More than one missed appointment in this fashion will require deposits for future appointments. Consecutive cancellations for rescheduled appointments will require deposits for subsequent appointments.

Appointment Booking. Each service requires a predetermined amount of time. Removing services at the appointment are processed as same day cancellations. Valid credit card is required to book an appointment. Payment for late cancellation/no show will be chargerd to the card on file - Declined payments need to be paid prior to booking future appointments and online booking will be unavailable until then.

Contraindications. I will address any concerns and contraindications (products, conditons, and pre-existing conditions that could make me sensitive to waxing) with Nautiwax LLC. I provided an accurate account of the questions asked above. Nautiwax LLC takes every precaution to minimize or eliminate negative reactions.

Release, Hold Harmless. This constitutes full disclosure and I certify that I have read and fully understand this consent form. I understand the services offered and accept all risk and liability. I release, discharge, and hold harmless Nautiwax LLC of all liability that may result from or in connection to the services provided by Nautiwax LLC.

I further certify and represent that I have the legal authority to waive, dischage, release, and hold harmless Nautiwax LLC on behalf of myself.

Signature*

Parent or legal guardian signature *

Date*