Treatment Model Request & Consent

Treatment Model Request & Consent
Thank you for your interest in being a model for Luxe Skin Care. Please take a moment to complete this Treatment Model Request & Consent form. To receive any cosmetic injections, you must be at least 18 years of age. For all other treatments, under 18, must have parental consent.
Full Name
Date

MonthDayYear
Date
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Address

Street Address Line 2

CityState

Zip
I am interested in being a model for:
IMPORTANT: PLEASE READ CAREFULLY and check box and complete form.
WARNINGS: PLEASE READ CAREFULLY and check box and complete form.
File Upload

Please include pictures of your face. Take 5 photos of your face, make up free and clean then upload them below. NOTE: Before uploading, please rename photos with last name, first name Ex: smith-mary-jpg- One from each side- One straight on- One from a 45 degree angle from each side- Do not use a flash and make sure the room is well lit.
Cancelof
Is there anything else you think I should know?
I understand the above and have answered truthfully. I hereby agree to all the above and, have been truthful with my asnwers and agree to be a model and have a treatment performed on me.
Signature of Client
Date

MonthDayYear
Date
Signature of Parent/Guardian if under 18
Date

MonthDayYear
Date
Should be Empty: