Nail Salon Consent Form

PLEASE READ!!* This field is required.

I acknowledge that the nail salon, nail technician, and the other employees are humans and should be treated with respect all the time.

I understand that I need to fill up a separate form related to the COVID-19 safety precautions.

I confirm that the nail salon and the nail technician will not be responsible or liable if the result of the service is not as expected as it should be.

I am allowing the nail salon and the nail technician to apply necessary chemicals as part of the service in my nail treatment.

I agree that the nail service is final after the service.

I understand that kids are not allowed in the work service area for safety reasons.

I have read this whole document and I accept the terms indicated above.

ALL SALES ARE FINAL!!

Please note before you continue that Mya Kutei IS NOT a licensed tech! She is a student and will not receive a physical license until 2024! With that being said she is a Student and withholds a students permit digitally through her school! I the reader understand that continuing this form and submitting it means I understand this and am willing to have an unlicensed tech do my nails and/or hair! That means I the reader also understands there will be no liability against Mya for any mistake or unsatisfactory with my services( if not spoken up during the process, etc) Please print initials:* This field is required.

PHOTOGRAPHY AND VIDEOGRAPHY RELEASE CONSENT Our insurance company requires “Before” and “After” photos/videos be taken and kept on file. We would like your permission to use these photos/videos for advertising. For example, in portfolios, online and in print adds, etc. Your consent is necessary regarding this. Please check if you would like your photos/video used or not used in advertising.* This field is required.

YES i’m fine with being on camera!

NO thanks i’ll pass!

POSSIBLE RISKS, HAZARDS OR COMPLICATIONS -Pain:There can be pain if injury occurs from nail tools/ hair tools/ accidentally human infliction. -Infection: Infection is very unusual. The areas treated must be kept clean an only freshly cleaned hands should touch the areas. -Asymmetry: Every effort will be made to avoid asymmetry but our fingers/ nails/ heads are not symmetrical. -Allergic Reaction: There is a small possibility of an allergic reaction. If you are allergic to any nail products/hair products or think you may be DO NOT GO FORWARD WITH THE SERVICE/ AND OR PLEASE TELL ME SO THAT I CAN PROVIDE A DIFFERENT PRODUCT FOR YOU! STATEMENT OF CONSENT AND RECITALS Please read and initial all lines _____ Aftercare instructions have been explained to me and a written copy will be given to me to retain in my possession, which I will follow to the best of my ability. If I have questions I will call or email you. _____ I understand that there is a possibility of discomfort associated with this service and that swelling, redness and bruising may occur. _____ I accept the responsibility for explain to you my desire for specific colors shape, and position for any service done today. _____ I understand that Lifting, breaking, and nail retention (growth) is bound to happen- hence it is a protective “style” and a Fake extension on my nail. _____ I understand that my body’s reaction to any products are not on the stylist/tech nor the client and that i am responsible for telling them my allergies or health issues before hand. _____ I acknowledge that the proposed procedure(s) involved risks inherent in the procedure and have possibilities of complications during and/or following the procedures such as: infections, misplaced pigment, poor color retention and lifting/breakage . _____ I have been quoted the cost of today’s appointment and there will be no refunds for this elective service (s) or no shows . _____ I accept full responsibility for the decision to have this cosmetic service done. ____ I understand I am responsible for paying a deposit that goes towards my service and if I do not show there will be no refund . ___ i understand if Mya feels she has made a mistake she will find a solution that best fits the situation which CAN be a refund , reschedule, fix appointment, or a free service. ___ i understand Mya’s one person policy and if i am a minor and need to bring a parent i let Mya know so that she can admit you to the location or travel to you . ___ I understand If Mya travels to you for a service a 25$ deposit is required which is non refundable. Also i understand that any furniture tarnished or ruined from the products used on my service is not her fault ! I again understand that if i have pets in the home they be put up and away from chemicals or products as Mya isn’t liable for any harm the chemicals may do to your animal is ingested . __ I Understand if Mya thinks your living space is not safe or feels comfortable in the space she has the right to leave and reschedule you to come to her location ! The deposit still goes towards my next service ! I certify that I have read or have had read to me the contents of this form. I understand the risks and alternatives involved in this procedure(s) and I have had the opportunity to ask questions and all of my questions have been answered. __I read & understand Mya’s policies on the page @jedijunky on instagram , located on her highlights. I acknowledge that I have reviewed and approved the material given to me and I authorize Mya, as my cosmetics technician to perform on my body the following service(s) . Signature______ (Type name : Last, First , Middle Inital)* This field is required.Sign Initials on next page

Signatureper last page

PLEASE COMPLETE OR I WILL NOT GO FORWARD WITH YOUR SERVICE! Do you presently have or previously had any of the following: (Number answers and state YES or NO) YES/NO :Diabetes| YES/NO :Hepatitis (A, B, C, D)| YES/NO: Easy bleeding| YES/NO:Maladaptive Nail biting| YES/NO: Migraines or frequent headaches| YES/NO: previous nail damage| YES/NO: psoriasis or eczema| YES/NO recent surgeries on Hands/Feet/Head| YES/NO Pregnant now/Breast feeding now| ____________________________________ YES NO Allergic reaction to any topical medications or products? YES/NO Allergies to metal, food, latex, chemicals etc? ____________________________________ YES/NO Any diseases or disorders not listed? ____________________________________ I agree that all the above information is true and accurate to the best of my knowledge.* This field is required.

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Other

Type of Service* This field is required.

Customer's Name* This field is required.

First Name

Last Name

Phone Number* This field is required.

Email Address* This field is required.

example@example.com

Email Verified

The verification code has been sent to some@email.com
Please check your mailbox and paste the code below to complete verification

••••

Date of Birth* This field is required.

Date

By signing below, you confirm that you have provided accurate and current information on this form. I affirm that I have made this consent and waiver voluntarily. In any case that I decide to withdraw or revoke my waiver, I may do so by submitting a written request signed by me to the salon company.

Signature* This field is required.per last page

Date Signed* This field is required.

Date

Schedule me for …

Please verify that you are human* This field is required.hehe