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The Naked Peach Waxing Boutique Waxing Release Form

Today's Date: February 26, 2024

Please note: Waxing and threading does have certain side effects such as skin removal, redness, swelling, tenderness, bruising, allergic reaction to wax etc. I have read the below information and if I have any concerns, I will address these with my technician. I give permission to my technician to perform the waxing and or threading services I am requesting and will hold him/her and The Naked Peach Waxing Boutique harmless from any liability that may result from waxing and or threading treatments. I have given an accurate account of the questions I have and they have been answered truthfully and completely to the best of my knowledge. I understand the below questions and have had sufficient opportunity for discussion to have any questions answered. I understand the waxing and threading procedures and accept the risks. This waiver and release is effective for any and all visits to The Naked Peach Salons.

 



Please select who will be participating...
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First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information


We only do brazilian/manzilian-bikini/mankini over 18 years of age.


Some medications may cause skin thinning and may make waxing/threading less suitable and cause adverse reactions. Some medications include: Accutane, Chemotherapy drugs, Retinoids, Oral or Topical Corticosteriods, Blood Thinning Medications, and Antibiotics.


Sunbathing within 72 hours of wax/threading and using body/facial products with AHA/BHA's within 72 hours of wax/threading may cause an adverse reaction as well.


If you are taking any medications please consult with your health care provider to find out if your medications will be suitable and safe for waxing/threading

Do you agree that you will contact your health care provider if you have any questions regarding the medications you are taking; and the effects that it might have on the safety of your waxing/threading service?*
No
Yes
Have you ever had an adverse reaction to waxing in the past?*
No
Yes
Do you agree that you will consult the manager or service provider on staff if you have any concerns about your waxing/threading service today, as well as future services?*
No
Yes
First Participant's Signature*
Participant's 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*
Check to receive information, news, and discounts by e-mail.
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 Date of Birth*
Parent or Guardian's Information


We only do brazilian/manzilian-bikini/mankini over 18 years of age.


Some medications may cause skin thinning and may make waxing/threading less suitable and cause adverse reactions. Some medications include: Accutane, Chemotherapy drugs, Retinoids, Oral or Topical Corticosteriods, Blood Thinning Medications, and Antibiotics.


Sunbathing within 72 hours of wax/threading and using body/facial products with AHA/BHA's within 72 hours of wax/threading may cause an adverse reaction as well.


If you are taking any medications please consult with your health care provider to find out if your medications will be suitable and safe for waxing/threading

Do you agree that you will contact your health care provider if you have any questions regarding the medications you are taking; and the effects that it might have on the safety of your waxing/threading service?*
No
Yes
Have you ever had an adverse reaction to waxing in the past?*
No
Yes
Do you agree that you will consult the manager or service provider on staff if you have any concerns about your waxing/threading service today, as well as future services?*
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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