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Client Consent Form

Please fill out all sections before your first appointment .


I am aware and fully understand the possible benefits, risks, side effects and complications of the procedures I have elected to undergo. I also understand that it is impossible to list every risk or potential complication of a particular procedure. To the best of my knowledge, I have provided to the company an accurate account of my medical history, allergies, and any prescription drugs which I am ingesting.

Client Initials


I recognize there are no guaranteed results with any procedure and that independent results are dependent upon age, body 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 understand that the procedure is being performed by a technician and I am not being treated by a professional with any medical qualifications. I understand that the technician is not going to examine me for any health concerns and that I am assuming the risk of any potential complications from previous conditions I may have even if I am not aware of them. If I am pregnant I understand that I must first consult with my doctor prior to receiving any procedure(s). 

Spray Tanning Rider: I understand that the FDA has directed that all people who receive spray tanning treatment avoid inhaling or ingesting any materials used in the treatment/procedure. I am fully aware that when receiving the treatment it maybedifficult to avoid exposure to sensitive areas. I acknowledge that I have been made aware of precautionary measures which I may take in order to potentially minimize such exposure. If I choose not to take such precautionary measures I am making such choice of my own volition. I further understand that I will be provided with aftercare instructions and that it is my sole responsibility to follow said instructions in order to maintain the integrity of the spray tan.

Client Initials


Teeth Whitening Rider: I am fully aware that the technician performing this procedure is not a dentist and possesses no formal dental qualifications. I understand that I should consult with a licensed dentist prior to treatment. I am also fully aware that multiple treatments could be required in order to obtain the desired results, and that veneers, porcelain, or other dental materials in my mouth cannot get any whiter than their original color. Finally, I understand that I am not a good candidate for this procedure if I have periodontal disease, fillings which are breaking down, or unfilled cavities.

Client Initials


CBD/PCR Toner Treatment Rider: This product is not for use by or sale to persons under the age of 18. This product should be used only as directed on the label. It should not be used if you are pregnant or nursing. Consult with a physician before use if you have a serious medical condition or use prescription medications. A Doctor's advice should be sought before using this and any supplemental dietary product. All trademarks and copyrights are property of their respective owners and are not affiliated with nor do they endorse this product. These statements have not been evaluated by the FDA. This product is not intended to diagnose, treat, cure or prevent any disease.

Client Initials


Waxing Rider: I understand that if I begin use or are currently using, Accutane,Retin-A, Differen, retinols, Renov-A,any product that causes skin sensitivity, have or had a recent sunburn, or use any medication or medical conditions that may cause adverse reaction I will not be waxed today. I accept full responsibility for any adverse effects or sensitivity if I choose to be waxed today despite these warnings. I understand that waxing may cause some temporary redness, bumps, or itching. 

Client Initials 


Authorization for Use of Photos and Images: I hereby grant permission for Shade & Seeker LLC to use photographs, provided by me by tagging @shadeadseeker on social media or authorized during my appointment and/or images of my completed treatment for use in marketing materials that include, but may not be limited to printed materials such as brochures and newsletters and digital images for use on Shade & Seeker’s website and social media outlets

Client Initials


I have read and understand the post-treatment home care instructions for the elected procedure(s). 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 Company immediately.

Refund Policy: If there is an issue with your final result, it must be reported and shown to us in-person within 24 hours of your appointment. We will happily work with you to remedy any perceived issue in a timely manner, but do not offer refunds under any circumstance. Deposits are non-refundable.

Client initials


I have read and fully understand this agreement and all information detailed above. I understand the procedure and fully and voluntarily accepting 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 Company or its employees and affiliates responsible for any of my conditions that were present, but not disclosed at the time of this procedure, which may be affected by the procedure performed today. 

Date: April 28, 2024




First Client's Name

First Name*

Last Name*

Phone*
First Client's Age Acknowledgment*
First Client's Date of Birth*
I certify that I am 16 years of age or older
First Client's Signature*
Second Client's Name

First Name*

Last Name*
Second Client's Date of Birth*
Third Client's Name

First Name*

Last Name*
Third Client's Date of Birth*
Fourth Client's Name

First Name*

Last Name*
Fourth Client's Date of Birth*
Fifth Client's Name

First Name*

Last Name*
Fifth Client's Date of Birth*
Sixth Client's Name

First Name*

Last Name*
Sixth Client's Date of Birth*
Seventh Client's Name

First Name*

Last Name*
Seventh Client's Date of Birth*
Eighth Client's Name

First Name*

Last Name*
Eighth Client's Date of Birth*
Ninth Client's Name

First Name*

Last Name*
Ninth Client's Date of Birth*
Tenth Client's Name

First Name*

Last Name*
Tenth Client's Date of Birth*
Parent or Guardian's Email Address

Email
Check to receive information, news, and discounts by e-mail.
A signed copy of this waiver will be sent to the email address you provide.
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*

Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 16 years of age or older
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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