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[Kanata] Lash Lift Consent
Lash Lift Consent - Personal Information Section
Name
(Required)
First
Last
Phone
(Required)
Date of Birth (For Birthday Promotion)
MM slash DD slash YYYY
Email
(Required)
Address
Street Address
State / Province / Region
ZIP / Postal Code
Consent section
I understand that there are risks associated with the Beauty Time centre Lash Lift procedure.
(Required)
I agree
I understand that the lashes will be curled with an advanced solution and a conditioning cream.
(Required)
I agree
I understand that as part of the procedure eye irritation, pain, itching discomfort and in rare cases of eye infection may occur.
(Required)
I agree
I understand and agree to follow the aftercare instructions provided by my technician.
(Required)
I agree
I understand failure to follow the aftercare instructions may cause an undesirable result.
(Required)
I agree
I understand that in order to have a Beauty Time Lash Lift, I will need to keep my eyes closed for duration up to 60 minutes during the procedure. I also understand that I will need to be lying in a reclined position. Any medical conditions that might be aggravated by lying still for a prolonged period of time may mean that I will not be able to have the procedure performed on my eyes.
(Required)
I agree
I understand that opening my eyes at any point during the Beauty Time Centre Lash Lift procedure is not recommended, and may cause an undesirable result. I agree to keep my eyes closed throughout the procedure unless instructed to open them by my technician.
(Required)
I agree
The risks of this procedure have been sufficiently explained to me .
(Required)
I agree
I have been advised to do my own research prior to proceeding and have chosen to proceed at this time.
(Required)
I agree
This agreement will remain in effect for this procedure and all future Beauty Time Lash Lift procedures conducted by my technician or any other technician conducting business at Beauty Time Inc. I understand that this agreement is binding and that I have read and fully understand all information above. I represent that I am over the age of 18 years.
(Required)
I agree
I release my technician works at Beauty Time Centre inc. from all liability associated with this procedure. For greater certainty, I hereby grant Beauty Time Inc a full, complete and final release and discharge from any claim based on contract, negligence, equity or torts whether past, present or future, which may have arisen or may arise against Beauty Time, its agents, contractors, its directors or officers, whether directly or indirectly, for any harm, injury or adverse consequence arising from this procedure. I also release beauty time from any cla im for legal costs associated with any of these matters.
(Required)
I agree
There are no guarantees for how long the lash lift will last, on average it last between 6-8 weeks. Our company or salon is not responsible for any technician errors. I understand that I have been advised to follow the aftercare protocol from my technician so as to avoid any discomfort or adverse side effects after the procedure has been completed.
(Required)
I agree
Signature
(Required)
Date
(Required)
MM slash DD slash YYYY
May we (Beauty Time Centre inc) take your photo?
(Required)
YES
NO
Photo and Video Consent section
PHOTO/VIDEO CONSENT
(Required)
I, the undersigned, give my irrevocable permission to Beauty Time Centre Inc., (BTCI), and/or
parties designated by BTCI, to photograph/video me and use such photograph(s)/video(s) in any
form of media, for any and all promotional/marketing purposes including advertising, display,
audiovisual or exhibition.
I acknowledge that these images may be used on various platforms owned, controlled by, or
associated with BTCI, including social media, the internet, print and any other suitable medium.
I further consent to the use of my name in connection with the photograph(s)/video(s) if needed
by BTCI and/or parties designated by BTCI.
I understand and agree that I will not receive any payment or compensation for my time or
expenses or any royalty for the publication of the photograph(s)/video(s) or the use of my name
and I hereby release BTCI and/or any parties designated by BTCI from any such claims.
My consent and release shall be binding on me and my estate.
I certify that I have read and fully understand this consent and release, and that all questions
pertaining to this consent have been answered to my satisfaction.
I agree to the photo and/or video policy.
Name
(Required)
First
Last
Date
(Required)
MM slash DD slash YYYY
Signature
(Required)
Parent Or Guardian (if client is under 18 years of age) Name & signature
Parent Or Guardian Name
First
Last
Signature Date
MM slash DD slash YYYY
Parent or Guardian Signature
Receptionist/Technician Section
Receptionist/technician Name
(Required)
First
Last
Signature Date
(Required)
MM slash DD slash YYYY
Receptionist/technician Signature
(Required)
58691
