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Release of Liability 

Zaria Rendon

Brown Sugar LLC

License # COS-FT-10180612

3620 SE Powell Blvd, Suite 203

Portland, OR 97202

Hair Removal and Skin Care Consent Form 


By initialing the following statements, you are giving Zaria Rendon of Brown Sugar LLC consent to perform sugaring (hair removal), and related skin care/beauty services under the Esthetician License number COS-FT-10180612. As well as relinquishing Zaria Rendon and Brown Sugar LLC of any and all Liability.

I understand sugaring can cause negative/allergic reactions, including but not limited to lifting, tearing, bruising, tenderness, inflammation, hives, ingrown hairs, etc.


I understand that if I choose to receive brow tinting and brow henna services from Brown Sugar LLC, I am aware that those services can cause negative/allergic reactions, including but not limited to itching, burns, swelling, irritation, rashes, redness, etc.


 

I understand any questions answered falsely, or information withheld deems Zaria Rendon and Brown Sugar LLC not liable of any negative/allergic reaction due to sugaring (hair removal), or related skin care/beauty services performed by Zaria Rendon of Brown Sugar LLC. 


I acknowledge I am agreeing to participate in sugaring (hair removal), and related skin care/beauty services performed by Zaria Rendon of Brown Sugar LLC, and I am hereby releasing Zaria Rendon and Brown Sugar LLC of any and all Liability.


Please come to your appointments showered, and free of lotions, oil, deodorant, or makeup. This can interfere with your results, and or mean we need to reschedule.



By initialing, you acknowledge you are aware that you cannot be serviced with active STDS/infections. BV/Uti/yeast infection/trich. If you are actively having a herpes outbreak you cannot be serviced at that time. If you have any rashes, open wounds or sores, you cannot be serviced in that area.



Please wear loose clothing, and cotton underwear the day of your appointment. You need to come with a minimum of 14 days of hair growth from your last shave, or 4 weeks from your last wax or sugar.



Cancelation Policy

All appointments need to be canceled 48 hours in advanced from your scheduled start time, to avoid a 50%-100% cancellation fee of your booked services. If you no show your appointment, you will be charged 100% of your services and will be terminated as a client. ALL APPOINTMENTS WILL BE CHARGED A 100% CANCELLATION FEE IF YOU CANCEL/RESCHEDULE WITHIN 12 HOURS OF YOUR APPOINTMENT START TIME. If you are late beyond being able to be serviced, that is considered a same day cancellation fee of 50% of all booked services. If you are continuously late beyond servicing, you will be charged 100% for missed appointments. All of the policies listed apply to your appointment as a whole, or portions of your appointment as well. So please cancel any appointment, or the portion you’re wanting to cancel in advanced to avoid cancellation fees. All fees must be paid before you book your next appointment, by the end of day of the missed appointment. If you fail to pay your cancellation fees you cannot book again. By initialing I acknowledge I have read, and understand the policy above, and that these policies are, and will be enforced. 

 


Social Media Release

I understand I may be asked by Zaria Rendon of Brown Sugar LLC for permission to take, and post photos to Brown Sugar LLC social media accounts. I have the right to select no, if no is selected no photos can be posted. If yes is selected Zaria Rendon of Brown Sugar LLC can post photos on Brown Sugar LLC social media accounts. You will be given a yes/no option once you get to the questionnaire portion of this waiver. Initialing is required no matter your answer.


Please select who will be participating...
AdultMinor
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First Participants Name

First Name*

Last Name*

Phone*
First Participants Date of Birth*
First Participants Information
Have you used Alpha Hydroxy Acid (AHA) or products containing glycolic within the last 72 hours?*
No
Yes
Are you currently using Retin-A, Renova or Accutane?*
No
Yes
Have you used Retin-A, Renova, or Accutane within the last 6 months?*
No
Yes
Have you used retinol, or other chemical exfoliants within the last 7 days?*
No
Yes
Are you using any other skin thinning products and/or medications that are blood thinners?*
No
Yes
Are you exposed to sun tanning/tanning beds on a daily basis?*
No
Yes
Are you diabetic? (Being diabetic reduces the ability for your skin to heal.)*
No
Yes
Do you bruise easily?*
No
Yes

Do you have any allergies? (If you do not have allergies put N/A) If so, please list: *

Are you currently taking any medications?(If answer is no put N/A) If so, please list: *

What are your preferred pronouns? (For example, my pronouns are She/Her)
Do you give Brown Sugar LLC permission to post photos on business social media accounts if asked?*
No
Yes
First Participants Signature*
Participants Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
zaria@brownsugarpdx.com
Click to customize section title
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
Have you used Alpha Hydroxy Acid (AHA) or products containing glycolic within the last 72 hours?*
No
Yes
Are you currently using Retin-A, Renova or Accutane?*
No
Yes
Have you used Retin-A, Renova, or Accutane within the last 6 months?*
No
Yes
Have you used retinol, or other chemical exfoliants within the last 7 days?*
No
Yes
Are you using any other skin thinning products and/or medications that are blood thinners?*
No
Yes
Are you exposed to sun tanning/tanning beds on a daily basis?*
No
Yes
Are you diabetic? (Being diabetic reduces the ability for your skin to heal.)*
No
Yes
Do you bruise easily?*
No
Yes

Do you have any allergies? (If you do not have allergies put N/A) If so, please list: *

Are you currently taking any medications?(If answer is no put N/A) If so, please list: *

What are your preferred pronouns? (For example, my pronouns are She/Her)
Do you give Brown Sugar LLC permission to post photos on business social media accounts if asked?*
No
Yes
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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