Nail Polish Appointment Scheduling Form 💅✨🎉
Student Full Name
*
First Name
Last Name
Parent Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent Email Address
*
example@example.com
Date of Birth
 -
Month
 -
Day
Year
Date
Choose the time that works best for you
1:00 pm
1:15 pm
1:30 pm
1:45 pm
2:00pm
2:15 pm
2:30 pm
2:45pm
3:00 pm
3:15 pm
3:30 pm
3:45 pm
4:00pm
4:15pm
4:30 pm
4:45 pm
Waiver and Hold Harmless Agreement: I, the undersigned, acknowledge that nail polish services involve risks including allergic reactions, skin irritation, infection, or damage to nails. I voluntarily assume all risks associated with these services. I release, waive, and hold harmless The Dearborn County Health Deparetment and other organizational partners and its owners, employees, and contractors from any and all claims, liabilities, damages, or costs arising from or related to the services provided, except for claims arising from gross negligence or intentional misconduct. I confirm that I have disclosed any known allergies, medical conditions, or medications that may affect my treatment. By checking the box and signing below, I acknowledge that I have read, understand, and agree to this waiver.
Hold Harmless Waiver
*
Signature
*
Signer Name
*
First Name
Last Name
Date
*
 -
Month
 -
Day
Year
Date
Book Appointment
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