Parent/Guardian Consent Form

Parent/Guardian Consent Form

Includes minor's medical history, appointment preferences, and parent's consent & liability. Please fill it out truthfully and to the best of your ability, it should only take around 5-10 minutes. Should you have any questions or concerns, feel free to contact me at beautybyjemdj@gmail.com or Instagram @thebeautyjem.
Parent's Personal Information
Parent's Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Minor/Child's Personal Information
Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Instagram username – this is my preferred form of contact (If you don't have one, I will be contacting you through text).

Medical History

Please answer carefully and truthfully for your aesthetician to determine whether your child is suitable and able to undergo the procedure and to rule out any contraindications
Does your child have any allergies? If yes, please explain.
Is your child on any medications? If yes, please explain.
Does your child have any medical condition(s) that may need accommodations during their appointment? If so, please explain what and how I may be able to accommodate them and provide a relaxing appointment.
Does your child have, or are currently being treated for an eye infection or eye injury? How about an infection, injury, active acne breakouts, sunburn, tear, cut, or any skin condition around the facial area? If yes, please explain.
Has your child had any reactions to skincare, lash or brow products, lash glue, lash lift solutions, brow lamination solutions, hard wax, hair dye or lash/brow tint before? If yes, please explain.
BROW LAMINATION AND/OR FACIAL TREATMENT CLIENTS ONLY: Does your child use any acne medication (topical or oral) and/or skincare with active ingredients such as, AHA/BHAs, exfoliants, retinols? How often? (They will need to avoid using these for at least TWO weeks before your appointment as it can cause a reaction with the products used during their service.)
Does your child wear contact lenses? (If yes and they are coming in for any lash and/or facial services, please get them to come in to their appointment WITHOUT contact lenses as they might provide discomfort or cause an infection/reaction).
Would you like your child to do a patch test for lash and/or brow services prior to their appointment? This tests for any allergic reactions to any products used and is typically scheduled 3 days prior to the appointment.

Parent/Guardian Consent Form

Parent's Personal Information

Minor/Child's Personal Information

Medical History

Parent Consent & Liability