Your permission is being requested by Nasya Simon at STUDIO XV LLC for your child's name* to receive an eyelash extensions service. By signing this form, I give my informed consent for my child to participate in the eyelash extensions service. I understand that on rare occasions there are risks associated with having artificial eyelashes and eyelash extensions applied to or removed from the natural eyelashes. I agree that if I may see my child experiencing any conditions with their eyelashes that I will contact the esthetician immediately!By signing this form, I hereby release any and all persons representing STUDIO XV LLC from all claims, demands, damages, actions and causes of action arising out of the performance of the service. Should the parent/guardian choose not to sign the consent form, services will not be accepted by the esthetician under any circumstance until consent is given by parent/guardian. *This consent form will be on file during the duration of time that your child is receiving these services. You may revoke this consent at any given time. Please feel free to contact me via text if you have any questions or concerns. Contact Information - 276.966.4056