I have agreed to have HerKandyGlam LLC apply semi-permanent eyelash extensions to my natural eyelashes. I understand I must complete this agreement and provide my informed consent by signing and dating where indicated below.
*Waiver of Liability. I understand there are risks associated with having artificial eyelashes applied to and/or removed from my existing eyelashes, and that notwithstanding the utmost of care in the application or removal of these products, there still exist risks associated with the procedure and product itself, which include, without limitation, eye irritation, eye pain, discomfort, and, in rare cases, blindness when improperly handled. As part of this procedure, I understand that a certain amount of eyelash adhesive material will be used to attach the artificial lashes to my existing eyelashes. Even though the Professional may apply or remove my lashes properly, I understand adhesive material may become dislodged during or after the procedure, which may irritate my eyes or require further follow-up care, at my own expense to prevent damage to my eyes. I also understand there is more than one technique for applying lashes to my eyelashes, and I will not attribute any liability to HerKandyGlam LLC as a result of this procedure or the use and care of these lashes. I also agree to defend, indemnify and hold harmless from any and all claims, actions, expenses, damages and liabilities, including reasonable attorneys' fees which might be asserted against them as a result of my having this procedure performed.
*Permission to Use Pictures. I hereby grant to HerKandyGlam LLC the full right to take, publish and reproduce photographs of me, my face, my eyes and/or eyelashes, both before and after this procedure, for any advertising, education, etc.
*Care and Maintenance. I agree to follow the care and maintenance instructions provided by HerKandyGlam LLC for the use and care of my lashes, and that if any follow up care is required due to my own mistake or negligence, or failure to follow these instructions; this will be at my own expense and risk. I understand that if I do any of the following, it may result in damage to my lashes to fall off prematurely. Knowing this I agree to follow these tips for best results: I will avoid oil based eye products as these will loosen the bond of my adhesive. I will avoid getting my lashes wet within the first 24 hours after my application. For the first two days after application I understand it is best to avoid swimming, saunas or steam rooms. If I experience any itching or irritation, I agree to contact HerKandyGlam LLC immediately to have the lash extensions removed. I agree to avoid using waterproof mascara and to not use an eyelash curler, perm, or tint my lashes. I agree to not pick, pull or rub my lashes. I understand that I should not attempt to remove my lash extensions on my own or with any product, but that the procedure requires that my lash extensions be professionally removed.
*No Known Medical Conditions / Informed Consent. I have read and completed the Client Intake Form in its entirety and in truth. I acknowledge that I have been advised of the potential harmful or negative side effects (such as the premature shedding of my eyelash) that the lash extension procedure or removal may cause to those who have specific medical or skin conditions. I understand that the adhesives and adhesive remover are a skin, eye and mucus membrane irritant and that in rare cases persons may be allergic or have hypersensitivity to synthetics, cyanoacrylates or formaldehyde which in small amounts may be present in the adhesive. I understand that the procedure requires that I lay still for up to 2/3 hours or longer with my eyes shut. I further state that I have no known medical condition that might be aggravated by the procedure or any medical condition that would prevent me from complying to HerKandyGlam LLC's instructions or these warnings. If any action is brought to enforce the terms of this Agreement, the prevailing party shall be entitled to its costs and reasonable attorneys' fees. Any claims arising out of this agreement will be resolved through binding arbitration using the rules of the American Arbitration Association. This agreement will remain in effect for this procedure, and all future procedures conducted by HerKandyGlam LLC. I agree that this Agreement is binding upon me, and my heirs, legal representatives and assigns. I represent that I am over 18 years of age and that I have the right to enter this agreement, or if I am under 18 years of age, I have had my parent or legal guardian consent to this agreement, and his or her relationship to me is as follows: By his or her signature below, he or she ratifies and consents to this procedure under these terms.