Makeup Consultation Form

Name

First NameLast Name

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Format: (000) 000-0000.

Skin Type

What skin products do you typically use? What is your daily routine?

What kind of makeup do you normally wear? Please list products and brands

How often do you wear makeup?

Are you allergic to any makeup products or do you have any skin allergies?

Have you had a high fever/severe illness in the past two weeks?

What are your biggest concerns when it comes to makeup?

Please read each statement. By clicking each box you acknowledge, understand and agree to the following:

Release. I recognize that there are certain inherent risks associated with the above described service/treatment and assume full responsibility for injury to myself. In exchange for such treatment, I hereby fully release and forever discharge Bloom Beaute Studio LLC and Ashley Alvior (including members, owners, employees and agents) from any and all damages, costs, expenses, liabilities, causes of action, claims and demands, of character, in law or in equity whether known or unknown, direct or indirect, asserted or unasserted and whether or not on account of myself, Bloom Beaute Studio LLC, Ashley Alvior or other third parties, or in any way arising out of the above described service I have requested Bloom Beaute Studio LLC or Ashley Alvior perform. It is the intention of the parties that this agreement binds all parties whose claims may arise out of treatment or services provided by Bloom Beaute Studio LLC, Ashley Alvior including any spouse or heirs of the client/patient and any whether born or unborn. Any legal or equitable claim that may arise from participation in the treatment or service shall be resolved under Hawaii state law to indemnify, hold harmless and defend Bloom Beaute Studio LLC, Ashley Alvior (including its officers, members, owners, employees and agents) all third party claims, causes of action damages, judgments, costs or expenses, including attorneys' fees and other litigation costs, which may in arise from the above described treatment I have requested Ideal Bloom Beaute Studio LLC and Ashley Alvior perform.Arbitration. It is understood that any dispute arising as to malpractice of makeup service shall be decided by a neutral arbitrator. Any arbitration proceeding will be governed by Hawai’i arbitration statute, the fees for the arbitrator will be split pro-rata among the parties and each party will be responsible for their own attorneys' fees and costs. Any action to collect fees from the client/patient for the treatments performed brought in any court located in Hawai’i and the prevailing party in such collection action shall be entitled to recover its reasonable attorneys' fees and costs. Filing of any action in any court to collect any fee from the client/patient shall not waive the right to compel arbitration of any malpractice claim.

By sigining below, I acknowledge, understand and agree to all information in this consent and hereby release any and all persons representing this Bloom Beaute Studio LLC and Ashley Alvior from all claims, demands, damages, actions and cause of action arising out of their performance of the service. I have fully disclosed all condtions regarding my health and well-being. I am over 18 years of age and consent to the agreement and to the service and makeup application and hair design.

Date

Signature