Consent and Policy Form

Full Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState

Postal Code

Phone Number*

Area CodePhone Number

E-mail*

List Medications: birth control & hormonal therapy can affect thinning of natural hair/lashes & hair color service. Retinol & antibiotics can cause tearing of skin during wax services.

Please note any known allergies, including known reactions.

How did you hear about us?*

Other

Referred by:

POLICIES

Please read through carefully as exceptions will not be made if the following policies are breached. This is to ensure the safety and satisifaction of you and your service provider.

Cancellations or rescheduling of appointments less than 24 hours are subject to a late cancellation fee up to the full amount of scheduled services. A minimum fee of $50 per hr scheduled will be charged. Missed or no showed appointments will be charged $100 per hour scheduled. Two no-shows or cancellations require a non-refundable deposit of 100% of scheduled services for future appointments. Late arrivals of 15 minutes or more will result in automatic cancellation of your appointment and will be treated as a no show. Before booking, please note that this policy is nonnegotiable, even for illness.*

I agree

A credit card must be on file to book appointments. This card is subject to fees associated with late cancellations and no shows, as agreed to above.*

I agree

Lara Imler has the right to refuse service if any of the above policies have been breached without penalty or threat of legal action, including and not limited to credit card disputes for late cancellations or no show charges as agreed above.*

I agree

Services are guaranteed within 7 days of original service. Styles or results outside the scope of the original consultation will be scheduled and charged as a new appointment.*

I agree

I consent to “before and after” photographs. I give Lara Imler, the right and unrestricted permission to take, use, and display photographic images of me, through any form of media or any other lawful purpose. I waive any right to royalties or other compensation arising from or related use of photographic images of me. I release and agree to hold harmless /Lara Imler from any liability in connection to taking or using said images.

I agreeI agree, but no face photos pleaseI do not agree to photos

WAIVER RELEASE

I authorize Wayward Octopus Studio/Lara Imler to perform hair, skin, and lash services; as requested. I understand these procedures may require chemical products that may cause allergic reactions. Some cases may result in complications, such as transient irritation and allergic reaction to the products used.

If at any time I am uncomfortable with procedure, I will inform the stylist and they will rectify the problem, including ending the session if I (or the stylist) wish. If the stylist is uncomfortable with a service, she will discuss their concerns with me and may end the session if necessary.

It has been represented to me that no guarantees, warranties, promises, commitments or other statements as to the results of this service have been made, and I acknowledge that I have received no particular representations or guarantees, and I am consenting to procede with services at my own risk.

I, as herein signed, release Lara Imler from any claims or damages of any nature.

I, the client herein signed, certify that I have read and had explained to me and fully understand the above waiver form.

I certify that I have consulted with Lara Imler or have completed the Client Consultation & History Form to the best of my knowledge.

I certify I am of sound mind, and I am fully capable of executing this waiverform for myself. I, the undersigned client, acknowledge and fully understand that there might be other unknown risks not reasonably foreseeable at this time.

Date Signed*

Date

Signature*

Client Policy & Waiver Form