RELEASE OF LIABILITY, WAIVER OF CLAIMS, AND INDEMNITY AGREEMENT
GENERAL LIABILITY WAIVER AND ACKNOWLEDGMENT
In consideration of the risk of injury while participating in Beauty Salon services, I am voluntarily participating in the aforementioned activity at my own risk. I am aware of the risks associated with traveling to and from, as well as participating in this activity, which may include, but are not limited to, physical and psychological injury, pain, suffering, illness, and disfigurement.
This place of business is not responsible for lost or stolen valuables, nor will this place of business be held liable for any injury or condition that arises from any kinds of purchase of goods and services despite completion of this form. This form is intended as an assessment tool only and serves as first-hand information, not for medical treatment or medical assessment.
Form completion is for the person who is to receive the Services (hereinafter the "Client"), whether you are an adult Client completing the Form for yourself or the Parent/Legal Guardian completing the Form for the minor Client age 18 or under who is identified above as a Client. Clients under the age of 18 must have a parent or legal guardian present to provide a signature for authorization for the required Beauty Salon goods and services.
It is my choice to receive the Beauty Salon services and goods. I realize that the treatment is being given for the well-being of myself. I understand that the service providers do not diagnose illness, disease, or any physical or mental disorder, nor do they prescribe medical treatment or pharmaceuticals. I acknowledge that Beauty Salon services are not a substitute for medical examination or diagnosis. I agree to communicate with my service provider any time I feel as though my well-being is compromised.
I understand and voluntarily accept the risks associated with the services including but not limited to Brazilian Wax, Full Body Waxing, Facials, Eyebrow Tinting, Eyebrow Henna, Eyebrow Threading, Face Threading, Waxing (including full body), Henna Tattoos, Eyelashes (mink lashes and other kinds of lashes), or use of any products or sale of Beauty Salon products, or the use of any of the location's facilities.
I acknowledge and voluntarily assume the risk of injury, accident, or death which may arise from the use of any kind of services, event, or activity. I agree My Waxing & Threading will not be liable for death or any injury including without limitation personal, bodily or mental injury, economic loss, or damage to me resulting from negligence or other acts in the Beauty Salon, anyone acting on My Waxing & Threading's behalf, or anyone using the services of the facilities of the Beauty Salon, to the fullest extent permitted by law.
This agreement, together with My Waxing & Threading Beauty Salon rules and regulations, constitutes the entire agreement between you and us and cannot be amended, except in writing by both parties. Myself and/or any of my heirs, executors, representatives, or assignees hereby release My Waxing & Threading from all claims or liabilities for death, personal injury, or property loss or damages of any kind sustained while on the premises, during the use of any advice, services, or goods provided by an employee, independent contractor, or any representative of My Waxing & Threading.
I agree that this application and waiver is in effect for all services and goods purchased and will not expire unless specifically requested by either party. By signing this form, I agree to the above terms and release My Waxing & Threading, independent contractors, and its employees from any liability.
I agree to release and forever discharge and hold harmless My Waxing & Threading / My Beauty Salon LLC / KK Beauty Salon LLC / My Waxing & Threading LLC, its agents, shareholders, officers, and employees from any claims, damage, or conduct of any and all nature.
NOTE: Please note, if you have any type of allergy or medical condition that you think we need to know about, please tell us BEFORE you receive any services!
BODY & FACE WAXING WAIVER
Please note that waxing does have certain side effects such as skin removal, redness, swelling, tenderness, etc. If you have used Retin-A, Renova, or Accutane, or if you have used Alpha Hydroxy Acid or glycolic products in the past 48-72 hours, or are diabetic, please inform our technicians (as we will not be able to serve you for your safety).
If I have any additional concerns, I will address these with my skin therapist. I give permission to my therapist to perform the waxing procedure we have discussed and will hold her and her staff harmless from any liability that may result from this treatment.
I have given an accurate account of the questions asked above including all known allergies or prescription drugs or products I am currently ingesting or using topically. I understand my esthetician will take every precaution to minimize or eliminate negative reactions as much as possible.
I have read and understood the post-treatment home care instructions. I am willing to follow recommendations made by my esthetician for a home care regimen that can minimize or eliminate possible negative reactions. In the event that I may have additional questions or concerns regarding my treatment or suggested home product/post-treatment care, I will consult the esthetician immediately.
I agree that this constitutes full disclosure and that it supersedes any previous verbal or written disclosures. I certify that I have read and fully understand the above paragraphs and that I have had sufficient opportunity for discussion to have any questions answered. I understand the procedure and accept the risks.
I do not hold the esthetician or My Beauty Salon LLC - DBA My Waxing & Threading or My Waxing & Threading LLC / KK Beauty Salon LLC responsible for any of my conditions that were present, but not disclosed at the time of this skin care procedure, which may be affected by the treatment performed.
BROW / LASH TINT - HENNA BROW - BROW LAMINATION WAIVER
I understand that there may be some residual dark staining left on the skin following the tinting process of either my lashes, brows, or both. This will fade and go away within a short time.
I understand that, while every attempt will be made to provide me with my chosen color, everyone's hair absorbs color differently and my final results may not be the color I initially wanted.
I understand that over the course of several days, the color will gradually lighten and fade.
I have read the above information. If I have any concerns, I will address these with my skin care professional. I give permission to my skin care professional to perform the tinting procedure we have discussed, and will hold him/her and his/her employer, My Beauty Salon LLC - DBA My Waxing & Threading or My Waxing & Threading LLC / KK Beauty Salon LLC, harmless from any liability that may result from this treatment.
I have accurately answered the questions above, including all known allergies, prescription drugs, or products I am currently ingesting or using topically. I understand my esthetician will take every precaution to minimize or eliminate negative reactions as much as possible.
In the event I may have additional questions or concerns regarding my treatment, I will consult the esthetician immediately. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I certify that I have read, and fully understand, the above paragraphs and that I have had sufficient opportunity for discussion to have any questions answered.
I understand the procedure and accept the risks. I do not hold the esthetician, My Beauty Salon LLC - DBA My Waxing & Threading or My Waxing & Threading LLC / KK Beauty Salon LLC, responsible for any of my conditions that were present, but not disclosed at the time of this skin care procedure, which may be affected by the treatment performed today.
LASH SERVICES WAIVER
I understand there are risks associated with having artificial eyelashes applied to and/or removed from my existing eyelashes, and that notwithstanding the utmost care in the application or removal of these products, there still exist risks associated with the procedure and product itself, which include, without limitation, eye irritation, eye pain, discomfort, and, in rare cases, blindness even when applied in the usual manner.
If I experience any irritation, redness, puffiness, itchiness, an allergic reaction, or any other side effect of this procedure, I will contact a medical doctor immediately.
As part of this procedure, I understand that a certain amount of eyelash adhesive material will be used to attach the artificial eyelashes to my existing eyelashes. Even though the eyelash extension artist may apply or remove my eyelash extensions in the usual manner, I understand adhesive material may become dislodged during or after the procedure, which may irritate my eyes or require further follow-up care, at my own expense, to prevent damage to my eyes.
I also understand there is more than one technique for applying eyelash extensions to my eyelashes, and I will not attribute any liability to the eyelash extension artist as a result of this procedure or the use and care of these lashes.
As part of the removal procedure, I understand that a certain amount of chemical adhesive remover is applied to existing adhesives and a reaction occurs to dissolve the adhesive that results in the thinning of the remover. Even though the eyelash extension artist may apply or remove my eyelash extensions in the usual manner, I understand the liquid remover may seep into my eyes, which may irritate my eyes or require further follow-up care, at my own expense, to prevent damage to my eyes.
I also agree to defend, indemnify, and hold harmless the eyelash extension artist, My Beauty Salon LLC - DBA My Waxing & Threading or My Waxing & Threading LLC / KK Beauty Salon LLC, from any and all claims, actions, expenses, damages, and liabilities, including reasonable attorneys' fees which might be asserted against, as a result of my having this procedure performed.
FACIAL SERVICES WAIVER
I have voluntarily elected to undergo this facial treatment/procedure after the nature and purpose of this treatment has been explained to me, along with the risks and hazards involved. Although it is impossible to list every potential risk and complication, I have been informed of possible benefits, risks, and complications.
I also recognize there are no guaranteed results and that individual results are dependent upon age, skin condition, and lifestyle, and that there is the possibility I may require further treatments of the treated areas to obtain the expected results at an additional cost.
I have read and understand the post-treatment home care instructions. I understand how important it is to follow all instructions given to me for post-treatment care. In the event that I may have additional questions or concerns regarding my treatment or suggested home product/post-treatment care, I will consult the esthetician immediately.
I have also, to the best of my knowledge, given an accurate account of my medical history, including all known allergies or prescription drugs or products I am currently ingesting or using topically. I have read and fully understand this agreement and all information detailed above.
I understand the procedure and accept the risks. All of my questions have been answered to my satisfaction and I consent to the terms of this agreement. I do not hold the esthetician, My Beauty Salon LLC - DBA My Waxing & Threading or My Waxing & Threading LLC / KK Beauty Salon LLC, responsible for any of my conditions that were present, but not disclosed at the time of this skin care procedure, which may be affected by the treatment performed today.
Clients under the age of 18 must have a parent or legal guardian present to provide a signature for authorization of this facial session. It is my choice to get spa treatments. I realize that the treatment is being given for the well-being of my body and mind. I agree to communicate with my service provider any time I feel as though my well-being is being compromised.
I understand that the service providers do not diagnose illness, disease, or any physical or mental disorder, nor do they prescribe medical treatment or pharmaceuticals. I acknowledge that spa services are not a substitute for medical examination or diagnosis, and that it is recommended that I see a primary Health Care provider for that service. I have stated all medical conditions that I am aware of, and will update the service provider of any changes in my health status.
By signing below, I acknowledge and agree to the following:
1. ASSUMPTION OF RISK: I understand that beauty services including but not limited to eyebrow threading, Brazilian waxing, full body waxing, eyelashes, facials, and henna tattoos carry inherent risks including but not limited to: skin irritation, allergic reactions, burns, scarring, infection, temporary or permanent discoloration, temporary or permanent hair loss, and other complications.
2. ACKNOWLEDGMENT OF RISKS: I acknowledge that I have been informed of the potential risks associated with the services I am receiving. I understand that no guarantee has been made to me regarding the outcome of any service.
3. MEDICAL CONDITIONS: I have disclosed all relevant medical conditions, allergies, medications, and skin sensitivities. I understand that failure to disclose this information could result in adverse reactions.
4. RELEASE OF LIABILITY: I hereby release, waive, discharge, and covenant not to sue My Waxing & Threading, My Beauty Salon LLC, KK Beauty Salon LLC, My Waxing & Threading LLC, their owners, employees, agents, and independent contractors from any and all liability, claims, demands, actions, and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by me while receiving services or being on the premises.
5. INDEMNIFICATION: I agree to indemnify and hold harmless My Waxing & Threading, My Beauty Salon LLC, KK Beauty Salon LLC, My Waxing & Threading LLC, their owners, employees, agents, and independent contractors from any loss, liability, damage, or costs that may incur due to my participation in services, whether caused by negligence or otherwise.
6. PHOTOGRAPHIC RELEASE: I grant permission for My Waxing & Threading to use photographs of me and my services for promotional purposes, unless I specifically request otherwise in writing.
7. CONSENT TO TREATMENT: I certify that I am at least 18 years of age, or if under 18, this form has been signed by my parent or legal guardian. I have read this document in its entirety and I freely and voluntarily assume all risks of such hazards and agree to this waiver and release.