1. I have received an eyelash extension consultation with a [Dream Lash Studio] technician. I have provided all information regarding previous services to my eyelashes that may or may not affect the outcome of my service. My technician has explained to me the process s/he recommends for eyelashes and desired results.
2. I have given an accurate account of the questions asked above including all known allergies or prescription drugs or other products I am currently ingesting or topically using.
3. I understand there are potential harmful or negative side effects of the SERVICE(s) to those who have specific medical or skin conditions.
4. I understand that even with the utmost of professional care, there are built-in risks (potentially harmful or negative side effects) associated with having artificial eyelashes applied to and/or removed from my existing natural eyelashes and with any and all products used in the application and or removal. These built-in risks include but are not limited to:
● allergic reaction to the glue used to attach the eyelash extensions,
● eye irritation and redness,
● infection,
● discomfort,
● loss of natural lashes,
● blindness,
● disturbance and or disruption of vision,
● premature shedding of natural eyelashes,
● eye irritation, or
● eye pain
5. I fully understand that a reaction can occur at any time, even if I have received this SERVICE(s) on previous occasions. I further understand that if I have any concerns, I will seek medical advice prior to any SERVICE(s).
6. I understand adhesive material (glue) 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.
7. I understand there is more than one technique for applying artificial lashes to my natural eyelashes, and I will not attribute any liability to [Dream Lash Studio] as a result of this SERVICE or the use and care of these lashes.
8. I have been given aftercare instructions and product recommendations to best care for, preserve and prolong my service results. I will follow the recommendations for a home care regimen that can minimize or eliminate possible negative reactions. If I have additional questions or concerns regarding my SERVICE(s) or suggested home product/post-service care, I will consult with my technician immediately.
9. I have read the above information and if I had any concerns, I have addressed them with my technician.
10. I agree that this constitutes full disclosure, and that it supersedes any pervious verbal or written disclosures. I certify that I have read and fully understand the above information and that I have had sufficient opportunity for discussion to have any questions answered.
I understand the procedure and accept the risks.
11. I give permission to perform the SERVICE(s) we have discussed and will hold my technician and [Dream Lash Studio] harmless from any liability that may result from SERVICE(s). Furthermore, I do not hold my technician or [Dream Lash Studio], responsible for any of my conditions that were present, but not disclosed at the time of this procedure, which may be affected by the SERVICE(s) performed today.
12. I understand that this waiver means that I give up my right to bring any claims including for personal injuries, death, disease, property loss, or any other losses, including but not limited to claims of negligence. I further give up my right to any claim I may have to seek damages, whether known or unknown, foreseen or unforeseen.
13. I understand and agree that the laws of the state of [Washington] shall govern this waiver and release agreement.
14. I understand and confirm that by signing this form, I hereby waive and release [Dream Lash Studio] from any and all claims, of every kind and nature, including claims for personal injuries, death, disease, property loss, or any other losses, including but not limited to claims of negligence. I further give up my right to any claim I may have to seek damages, whether known or unknown, foreseen or unforeseen, arising from or in any way related to the services being provided to me by [Dream Lash Studio]. Such release shall extend to [Dream Lash Studio] successors, agents, officers, predecessors, parent, subsidiary, attorneys, employees, assigns, and representatives.
15. I agree that this Consent Form is legally binding on me, my heirs, legal representatives, and assigns.
16. I am over 18 years of age and have the legal right to sign this consent form on my own behalf.
OR
16b. I am over the age of 18 and as the parent or legal guardian of the named minor, mentioned above, have the legal capacity to sign this release. I have read the above and fully understand the contents. This release is binding upon me, my heirs, and legal representatives
17. I agree that by selecting the "Submit" button, I am signing this Consent electronically. I agree my electronic signature is the legal equivalent of my manual/handwritten signature on this Consent.