Brow Lamination CONSENT 2020

Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

I agree to have the service of Brow Lamination performed on me by Shiva of Browlissima Beauty. *

Initial

During the treatment, despite all precautionary measures, injury is possible. I will not hold the technician or performing this service on me responsible in any way for any damages or issues that may arise as a result the Brow Lamination procedure performed on me.*

Initial

Despite application of the most advanced and top ingredients, an allergic reaction is possible.*

Initial

The minimum or maximum duration of the lamination from the procedure cannot be determined with certainty.*

Initial

The technician and the business performing the service on me will not liable for any damages caused to eyebrows in any way caused by any reason, including allergic reaction, reaction to previous procedures such henna/tint/bleach on the brow hair, skin sensitivity, and my failure to follow the Brow Lamination Aftercare As part of the aftercare, apply a moisturizing product developed specifically for Brow Lamination to the results.*

Initial

To perform the Brow Lamination procedure in a safe manner, please answer the following health questions truthfully. We will keep all information disclosed in a confidential manner and will use it only for purposes of determining whether you are an ideal candidate for this procedure. Do you currently have and/or have had in the past, and/or have you experienced any of the following:

Skin diseases

Eczema

Allergies:

Are you pregnant?Do you have problems with healing of wounds?Have you tinted or bleached your eyebrows in the last 2 months using brow henna, henna or tint/dye/bleach?Did you in the last 14 days undergo surgery, in which you were you exposed to radiation, or any other medical interventions?Have you ever been allergic to, or have had an allergic reaction to perm solution?Have you ever been allergic to, or have had an allergic reaction to Hair Dye?Have used Retin-A or Retinol products the last 3 weeks?

I recognize and acknowledge that there are certain risks of personal injury or property damage related to my participation as a client, and I voluntarily agree to fully assume all of these risks, regardless of severity, that I may sustain as a result of participating in any and all activities connected with or associated with the application by the technician of brow lamination and/or coloring to my eyebrows using the Brow Lamination technique, including, but not limited to, injuries, damages and losses arising out of negligent supervision, tort, contract, products, or any other theory of recovery. Accordingly, I, for myself and my heirs, assigns, personal representatives, and next of kin, expressly waive and release any and all claims, now known or hereafter known, against the Business, and their employees, officers, directors, and agents of each and all of them (collectively, "Releasees"), on account of personal injury or property damage arising out of or attributable to my participation as a client, whether arising out of the negligence of any Releasees or otherwise. I covenant not to make or bring any such claim against any Releasee and forever release and discharge all Releasees from liability under such claims. All matters arising out of or relating to this waiver and release shall be governed by and construed in accordance with the internal laws of the USA without giving effect to any choice or conflict of law provision or rule (whether of the USA or any other jurisdiction Any claim or cause of action arising under this waiver and release may be brought only in the federal and provincial courts located in the USA and I consent to the exclusive jurisdiction of such courts. I understand that this waiver and release is intended to be as broad and inclusive as permitted by law and that if any portion hereof is held invalid, I agree that the balance shall continue in full legal force and effect. I further agree that if this waiver and release are not valid in the USA, it shall be construed as a covenant not to sue anytime, anywhere, and for any reason.

INITIAL*

I have received post care instructions and will follow them to ensure results of my procedure are satisfactory.*

Initial

I HAVE READ THE INFORMATION IN THIS WAIVER THOROUGHLY. I UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT. I HAVE THE CAPACITY TO PROVIDE INFORMED CONSENT AND IAM SIGNING THIS WAIVER AND RELEASE FREELY AND VOLUNTARILY.

Signature*

Print Name*

Date*

Date

Permission is granted to take photos of my eyes / face which may be used for marketing purposes on a website, salon or class.

Signature

CONSENT AND LIABILITY RELEASE TO BROW LAMINATION OF EYEBROWS

RISKS: I acknowledge and accept the following risks.