BEAUTY KULTURE STUDIO & ACADEMY
EYELASH EXTENSION CONSENT FORM
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Referred by:
*
Have you had Eyelash Extensions before?
*
Yes
No
By checking each field, you agree to the side statement
*
I am at least 18 years of age
I understand that this procedure requires single synthetic eyelashes to be glued to my own natural eyelashes.
I understand that it is my responsibility to keep my eyes closed & be still during the entire procedure, until my eyelash technician directs me to open my eyes.
I understand that some risks of this procedure may be, but not limited to, eye redness and irritation. The fumes from the adhesive may cause my eyes to tear up if I open my eyes.
I agree to disclose any allergies that I may have to surgical tapes, cyanaocrylate, and other acrylates, etc.
I understand that I am required to follow the eyelash technician aftercare sheet (below) in order to maintain the life of these extensions.
I agree to wait a minimum of 24 hours before getting my lash extensions wet to allow glue to properly cure.
I agree that by reading and signing this consent form I release the lash technician and Beauty Kulture Studio & Academy from any claims or damages of any nature.
I agree that I read and fully understand this entire consent form.
I give permission to show my before and after photos of my lash extensions to other potential clients, or use for marketing purposes.
Signature
SUBMIT
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