Please Read the below terms carefully, the following slide will ask for your signature.

By SUBMITTING THIS FORM, you voluntarily agree to & fully understand the following terms:
1) I am at least 18 years of age. If I am under 18 years old, this document has been signed by my Parent or Legal Guardian.

2) All information entered is true & correct to the best of my knowledge and ability.
3) I understand that my treatment is not intended and therefore will not prevent, diagnose, treat or cure any disease
4) I understand that the Esthetician is duly educated, licensed and insured to provide me with services & professional opinion on treatments & products to improve the appearance of the skin.
5) If necessary, the Esthetician will instruct me to receive clearance from my Healthcare Provider prior to receiving skin treatments.
6) I understand the risks associated with massaging, facials, and waxing include, but are not limited to:

• Increased blemishes (sometimes known as purging)
• Redness, Rashes, Nicks, Irritation or Breakouts
• Temporary Muscle Soreness or Bruising

I, therefore, agree to release and hold harmless Regina Wilkins Esthetics, LLC and all it's agents & representatives from any liability, in whole or in part concerning any outcomes of my treatment.
7) I understand the importance of informing the Esthetician of my medical and physical conditions and any changes to these. Failure to disclose can result in additional risks.
8) I understand that it is my responsibility to inform my esthetician of any
discomfort I may feel during the session so he/she may adjust
accordingly.
9) I understand that I or the therapist may terminate the session at any
time.

PHOTO & VIDEO RELEASE

I understand that photos will be taken of my skin before, during and or after my treatment session(s) for the purpose of maintaining my record as a client of Regina Esthetics: A Skincare Studio

These photos may be used for the following purposes:

• Educational, demonstration & marketing purposes in various channels
• any other purpose deemed necessary by the business or it's agents & representatives.

Photos of videos of my likeness may be adjusted, cropped or otherwise edited by representatives of the business as deemed appropriate.

I, therefore waive any rights of ownership & to inspect or approve any finished product wherein my likeness appears. Additionally, I acknowledge that I will not receive compensation, monetary or otherwise, for the use of these materials. 

I release and discharge Regina Wilkins Esthetics LLC & it's representatives from any and all claims, demands or causes of action that I may have or now in the future arising out of or relating to the use of these photographs or videos, including without limitation any clamins for libel or violation of any right of publicity or privacy. 

I understand that I can verbally revoke the permission of the use of my photos and or videos for educational, demonstration & marketing purposes. Photos & videos will still be taken during my session for purposes of my client record.