Waxing Consent Form

If you are under 18 years old, please get your parent's assistance in filling out this form. We will ask that the parent fill the form out in the salon with the child to ensure that consent is given. While the information below is for the child, the parent or legal guardian will need to add his or her signature at the end.

Name*

PrefixFirst NameLast Name

Age*

Birthday*

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Area CodePhone Number

Email*

example@example.com

Are you currently Pregnant?*

YesNo

When is your approximate due date?

Date

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

YesNo

Have you used Retin-A, Renova, or Accutane within the past year? If so, when?*

Are you using any other skin thinning products and/or drugs that thin the blood?*

YesNo

Are you currently taking any medications? If so, please list.*

Please list any illness/conditions which you are currently being treated for by a medical professional. *

Do you have any open skin lesions?*

YesNo

Do you have any allergies? If so, please list.*

Emergency Contact, Relationship

Emergency Contact Phone Number

Area CodePhone Number

I hereby grant permission to The Waxing Wahine to use photographs and videos taken of me online, in publications, and in other communications.*

YesNo

Please note that waxing can have certain side effects such as skin removal, redness, swelling, tenderness, etc. I have read the above information and have given an accurate account of the questions and if I have any concerns, I will address these with my Wax Specialist. I give permission to my to perform the waxing procedure we have discussed and will hold her harmless from any liability that may result from this treatment. I agree to adhere to all safety post care including: no peels, tanning, or wet room services; no swimming/spas/hot tubs for 48 hours after waxing; and all home skin care protocols as recommended by my service provider. I understand that my Wax Specialist will take every precaution to minimize or eliminate negative reactions as much as possible.

I have the right to refuse service :
Please keep in mind that under given circumstances I have the right to refuse or stop service(s) in any of the following circumstances in which case no refunds will be issued
The guest exhibits language or behavior which the service provider deems as an immediate or potential risk to the safety of the guest, service provider, or others around them
The guest shares any health or other information that the service provider deems unsafe for the guest to receive services
Refuses or DOES NOT complete proper service form(s)

Late, Cancellation/Reschedule, and No Show Policy:
Here at the Waxing Wahine, we understand unforeseen incidents occur. To be courteous to other guest, there is a 5-minute grace period for your appointment. After the 5-minute grace period, there will be a late fee of $30 added to your service.
COMMUNICATION IS KEY! Should you need to cancel or reschedule your reservation, we kindly request you do so AT LEAST 6 HOURS prior to your scheduled reservation via text (808) 209-3231 or booking app.
If you fail to reschedule or cancel prior to the 6 hours of your scheduled reservation, 50% of the services scheduled will be charged to the card on file.
If you are a NO SHOW to your scheduled reservation, 100% of the services scheduled will be charged to the card on file.
If for any reason the card does not go through due to late cancellation/no show, you will no longer be serviced at the Waxing Wahine.

Forms of payment:
• Cash*and card payments accepted
• Credit and debit cards with Visa, Mastercard, AMEX, etc.
• Taxes 4.712% + 3.5% convenience fee will be added to any card transactions

*If paying with cash, we ask you to bring enough for your service(s), since we do not carry change.

Signature*

Date*