WAXING CONSENT FORM

By submitting this form, you agree to have hair, skin, or body services during the pandemic.

First Name

Last Name

Street Address

Street address line 2

City

State

Zip Code

Phone Number

Haave you used any Alpha Hydroxy Acids (AHA) or glycolic products in the past 48-72 hours?

Yes

Have you used any Alpha Hydroxy Acids (AHA) or glycolic products in the past 48-72 hours?

Are you using any other skin thinning products and/or drugs that thin the blood?

Yes

Do you use tanning beds and/or are exposed to the sun on a regular basis?

Yes

Are you currently taking any medications? If so, please list.

Have you been treated for cancer? If yes, when and what types of therapies were used?

Please list any illness/conditions which you are currently being treated for by a medical professional.

Do you have any open skin lesions?

Yes

Do you have any allergies? If so, please list.

RELEASE

I understand that there is a risk that I may experience a negative reaction from the waxing services provided to me by Lena Taryanik. Some reactions that may occur including, bruising, redness, swelling, scabbing, pimples, raw skin, and/or rash. I nevertheless desire to relieve that Services and agree that Lena Taryanik shall not be responsible for these and any other reactions that I may experience from the Services. I understand that I should not expose my skin to hot tubs, bath, spa, sauce and or indoor tanning for at least 48 hours after receiving that Services.

This is a release. I release, discharge and hold harmless Lena Taryanik from a and all claims of liability of any nature for any damages or injuries I may suffer relating to the Services. By signing this release, I understand that I am giving up my rights to sue Lena Taryanik for any claims, damages or injuries relating to the Services. By signing below, I agree that I have read and understand the above, that the statements given above are accurate, and that I am agreeing to the release.

Client/Parent/Guardian Signature

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!