Loading...

Camouflage Tattoo Informed Consent.

All information is collected by Ivonne Sanchez Beauty pursuant to O. Reg. 136/18: PERSONAL SERVICE SETTINGS and The Personal Information Protection and Electronic Documents Act (“PIPEDA “).

Terminology

The words “I”, “you” and “your" are used interchangeably throughout this agreement and in all cases refer to you the client who is receiving the treatment or procedure.

“Practitioner”, “technician”, “instructor” and “we” means 10981508 CANADA INC. (“Ivonne Sanchez Beauty”), its staff or contractors.

 

SECTION 1: ACKNOWLEDGMENTS AND AGREEMENTS

Please read each statement and sign the end of this document to accept your acknowledgement and agreement to the following:

That I have been given a copy of this Consent and Liability Release (the "Release") prior to the CAMOUFLAGE TATTOO technique being performed on me.

That it is my responsibility to advise the technician of any concerns I may have before participating as a client/customer and having this service performed on me, even though I may have written it down in this Release.

That I have read and accepted the risks set forth in Section 2. I have been given the opportunity to ask questions, either by written or verbal communication, prior to signing this Release. As a result, I have sufficient information to give this informed consent.

That I must complete the Health Questionnaire in Section 3 before I can have this service performed on me. I understand my participation as a client may be refused depending on my responses, including but not limited to, if I am pregnant, nursing or if I have any allergies or contraindications.

That no warranty or guarantee has been made to me as a result of the Camouflage Tattoo technique, and that the final result cannot be guaranteed as each skin type is unique. Multiple treatments may be required in order to achieve the closest desired effect.

SECTION 2: RISKS

I acknowledge and accept the following risks:

1. During the treatment, despite all precautionary measures, injury is possible. I will not hold the technician or business performing this service on me responsible in any way for any damages or issues that may arise as a result of having the Camouflage Tattoo procedure performed on me.

2. Despite application of the most advanced and top ingredients, an allergic reaction is possible.

3. Despite all measures taken, the risk of with Camouflage Tattoo is that some tattooing induces physical damage to the skin, which may cause or promote infections if microorganisms are introduced under the skin during the process. The potential sources of microorganisms include:

  • Contaminated dilution mediums.
  • Contaminated and/or improperly reprocessed equipment or ink
  • Client’s own bacteria on the skin.
  • Unclean hands touching the treatment area.

Potential infections can be caused by bacteria (e.g., Mycobacterium spp. or Staphylococcus aureus), fungi (e.g., Candida endophthalmitis), or even viruses (e.g., human immunodeficiency virus [HIV], hepatitis B virus, hepatitis C virus). There have been outbreaks of bacterial infection (non-tuberculous mycobacterial) caused by ink that was contaminated prior to distribution. Such bacterial infection can cause several diseases such as lung disease, joint infection, eye problems, and other organ infections.

4. Although Camouflage Tattoo is considered to be permanent, the minimum or maximum duration of the pigmentation from the procedure cannot be determined with certainty. I understand that additional treatments may be required in order to achieve desired immediate results.

5. The technician and the business performing the service on me will not liable for any damages caused to me or my body in any way caused by any reason, including allergic reaction, reaction to previous procedures such as previous micropigmentation, or cosmetic tattoo on the skin, skin sensitivity, and my failure to follow the Camouflage Tattoo Aftercare Instructions. The use of after care products is required to achieve optimal results.

Additional Information

It is strongly recommended to avoid physical exercise the first 7 days. 

I Agree

I understand that it is forbidden to sunbathe for a minimum or 40 days. 

I Agree

I understand  that in the first 30 days it is forbidden to use sunblock, self tanning lotion or any substance that contains vitamin D or that stimulates the production of vitamin D, or any agent with photosensitizing agents. 

I Agree

I understand that should any other artist or beauty professional work over the treated area that this will void any expected results and the process may need to start over again. 

I Agree

I understand that the following 11 items are contraindications (conditions) that may disqualify me as a candidate for permanent makeup procedures:

  1. Infected skin disorder, open cuts, wounds, abrasions
  2. Patients with cardiovascular disease must have doctor’s consent
  3. A pacemaker is a direct contra-indication
  4. Highly anxious
  5. Epileptic – electrical currents may precipitate an attack
  6. Pregnancy – electrical currents may precipitate labor
  7. Sunburned or irritated skin
  8. Untreated sinusitis – can cause pain in sinus area
  9. Numb area without sensation
  10. Diabetes – a separate consent from physician may be required
  11. If currently taking blood thinners

If the skin becomes painful and increasingly red, then you may have developed an infection and you must consult your physician immediately.

In most cases, redness will begin to subside within 2-4 days, some cases may take longer if a more aggressive treatment is performed. Pinkness may take up to one month to fade. This is not uncommon.

I understand that the treated area can remain pink for up to 1 month or sometimes longer and will gradually lighten with time. (Each client will heal differently).

AVOID EXPOSURE TO DIRECT SUNLIGHT UNTIL THE AREAS HAVE COMPLETELY HEALED. (40 days)    

I have read and understand the contents of this consent.

Cancellation Policy and Reminders.

All bookings are recorded in an online booking system. This system will send an e-mail confirmation to you of your scheduled appointment at the time that the scheduling is made. The booking system will also send a follow-up reminder e-mail 24 hours prior to your scheduled appointment. Unfortunately, we do not have a telephone reminder service.

A $100 deposit is required in order to make a booking for services. This will be applied to your scheduled service subject to the cancellation policy.

All cancellations and appointment rescheduling requests must be made at least 48 hours prior to the start of your scheduled appointment time.

The following events will result in the loss of the $100 booking deposit:

  1. No-shows;
  2. Cancellations without a minimum of 48 hours notice; or
  3. Cancellations with 48 hours notice but where a new booking is not made

I understand and agree to the above cancellation policy.

Customer Satisfaction and Feedback.

If I am unhappy with the results or service, I will not take to the internet to air my grievances of Ivonne Sanchez, Ivonne Sanchez Beauty in any online forum including but not limited to: Google Reviews, Facebook Reviews, Instagram, Facebook, or Twitter. I will instead contact Ivonne privately in order to allow her to work with me to find a solution.

Today's Date: July 3, 2020

First Client's Name

First Name*

Last Name*

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

Age

How you found us:
Area(s) To Be Treated / Treatment Procedure (Please Check): *
Arms
Breasts
Aereola
Thigh
Other

If other:

SECTION 3: HEALTH QUESTIONNAIRE

To perform the Camouflage Tattoo procedure in a safe manner, please answer the following health questions truthfully. We will keep all information disclosed in a confidential manner and will use it only for purposes of determining whether you are an ideal candidate for this procedure.

Are you over the age of 18? (You must be 18 years of age to receive our services).*
No
Yes
Have you had a chemical or laser peel?*
No
Yes
Are you currently using Retin-A or "Alpha Hydroxy" skin care products? (If so, avoid use for 1 month following procedure)*
No
Yes
Are you allergic to topical antibiotic numbing creams or desensitizers?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you*
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes
Do you have any allergies? If yes, list in space provided at the end of the form.*
No
Yes
Are you currently taking medication for high or low blood pressure?*
No
Yes
Will you work out on the day of treatment?*
No
Yes

Botox (date of last treatment)

What is the date of service: *
Do you currently have and/or have had in the past, and/or have you experienced any of the following:
Hemophilia
Do you have problems with healing of wounds?
Diabetes mellitus (diabetes)
Hepatitis A, B, C, D, E, F
HIV +
Eczema
Are you prone to herpes?
Infectious diseases / high fever
Epilepsy
Cardiovascular problems
Do you have a pacemaker?
Are you taking medication for blood thinning (anticoagulants)?
Are you pregnant?
Are you breastfeeding?
Have you received tattoo, micropigmentation or camouflage tattoo in the past 6 months on the areas to be treated?

Please list any skin diseases:

Please list any allergies:

Please list any autoimmune diseases:

Please list any medications taken on a daily basis:
Have you consumed drugs or alcohol in the last 24 hours?*
No
Yes
Did you in the last 14 days undergo surgery, in which you were you exposed to radiation, or any other medical interventions?*
No
Yes
Have you ever been allergic to, or have had an allergic reaction to tattooing (tattoo pigments) or any of the related products used in the delivery of tattooing services?*
No
Yes

Please record the cost of your Camouflage Tattoo service.

SECTION 4: USE OF LIKENESS AND RELEASE (PHOTOS & VIDEO)

By participating as a client, I permit, authorize, and license the technician(s) and the Business and their employees, officers, directors, contractors, and agents of each and all of them ("Authorized Persons"), to display, publicly perform, exhibit, transmit, broadcast, reproduce, record, photograph, digitize, modify, alter, edit, adapt, create derivative works, exploit, sell, rent, license, otherwise use, and permit others to use my image, likeness, and appearance, and all materials created by or on behalf of my participation that incorporates any of the foregoing ("Materials") on a perpetual basis throughout the world and in any medium or format whatsoever now existing or hereafter created for publicity, advertising, and marketing purposes, and for any purpose they deem reasonably appropriate, without further consent from or royalty, payment, or other compensation to me. I agree that all right, title and interest in and to all such Materials is the exclusive property of the Authorized Persons. I understand that the Authorized Persons may keep or use the Materials now and in the future. I understand that although the Authorized Persons will endeavour to use my image, likeness, and appearance in accordance with standards of good judgment, they cannot warrant or guarantee that any further dissemination of my image, likeness, and appearance will be subject to their supervision or control. Accordingly, I release the Authorized Persons from all liability or responsibility that may arise from the acts that I have authorized or consented to in this Section.*
No
Yes

SECTION 5: GENERAL RELEASE AND WAIVER

I recognize and acknowledge that there are certain risks of personal injury or property damage related to my participation as a client, and I voluntarily agree to fully assume all of these risks, regardless of severity, that I may sustain as a result of participating in any and all activities connected with or associated with the application by the technician of brow lamination and/or colouring to my eyebrows using the Brow Lamination technique, including, but not limited to, injuries, damages and losses arising out of negligent supervision, tort, contract, products, or any other theory of recovery. I, for myself and my heirs, assigns, personal representatives, and next of kin, expressly waive and release any and all claims, now known or hereafter known, against the Business, and their employees, officers, directors, contractors, and agents of each and all of them (collectively, "Releasees"), on account of personal injury or property damage arising out of or attributable to my participation as a client, whether arising out of the negligence of any Releasees or otherwise. I covenant not to make or bring any such claim against any Releasee, and forever release and discharge all Releasees from liability under such claims. All matters arising out of or relating to this waiver and release shall be governed by and construed in accordance with the internal laws of Ontario without giving effect to any choice or conflict of law provision or rule (whether of Ontario or any other jurisdiction). Any claim or cause of action arising under this waiver and release may be brought only in the federal and Provincial courts located in Ontario, Canada and I consent to the exclusive jurisdiction of such courts. I understand that this waiver and release is intended to be as broad and inclusive as permitted by law and that if any portion hereof is held invalid, I agree that the balance shall continue in full legal force and effect. I further agree that if this waiver and release is not valid in Ontario, Canada, it shall be construed as a covenant not to sue anytime, anywhere and for any reason. *
I Agree
I HAVE READ THE INFORMATION IN THIS WAIVER THOROUGHLY. I UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT. I HAVE THE CAPACITY TO PROVIDE INFORMED CONSENT AND I AM SIGNING THIS WAIVER AND RELEASE FREELY AND VOLUNTARILY. *
I Agree

COVID-19 Screening Questions

If you have travelled outside of Canada (or have been exposed to someone who a confirmed case of COVID-19) within 14 days of your scheduled appointment you must have subjected yourself to a period of self-isolation and quarantine before you are eligible to receive any services at Ivonne Sanchez Beauty.

Have you travelled outside of Canada within the past 14 days of the scheduled day of treatment?*
No
Yes
If you have travelled outside of Canada (or have been in contact with someone with COVID-19) within the past 14 days have you developed a cough, fever, or experienced difficulty breathing?*
No
Yes
Click to customize question*
No
Yes
For personal services such as those offered at Ivonne Sanchez Beauty the nature of work performed requires close contact with colleagues and customers (i.e. within 2 metres). These interactions, as well as the need to touch work surfaces and equipment could increase the likelihood that we or you could come in contact with the virus. *
I Agree
First Client's Signature*
Second Client's Name

First Name*

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

Age

How you found us:
Area(s) To Be Treated / Treatment Procedure (Please Check): *
Arms
Breasts
Aereola
Thigh
Other

If other:

SECTION 3: HEALTH QUESTIONNAIRE

To perform the Camouflage Tattoo procedure in a safe manner, please answer the following health questions truthfully. We will keep all information disclosed in a confidential manner and will use it only for purposes of determining whether you are an ideal candidate for this procedure.

Are you over the age of 18? (You must be 18 years of age to receive our services).*
No
Yes
Have you had a chemical or laser peel?*
No
Yes
Are you currently using Retin-A or "Alpha Hydroxy" skin care products? (If so, avoid use for 1 month following procedure)*
No
Yes
Are you allergic to topical antibiotic numbing creams or desensitizers?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you*
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes
Do you have any allergies? If yes, list in space provided at the end of the form.*
No
Yes
Are you currently taking medication for high or low blood pressure?*
No
Yes
Will you work out on the day of treatment?*
No
Yes

Botox (date of last treatment)

What is the date of service: *
Do you currently have and/or have had in the past, and/or have you experienced any of the following:
Hemophilia
Do you have problems with healing of wounds?
Diabetes mellitus (diabetes)
Hepatitis A, B, C, D, E, F
HIV +
Eczema
Are you prone to herpes?
Infectious diseases / high fever
Epilepsy
Cardiovascular problems
Do you have a pacemaker?
Are you taking medication for blood thinning (anticoagulants)?
Are you pregnant?
Are you breastfeeding?
Have you received tattoo, micropigmentation or camouflage tattoo in the past 6 months on the areas to be treated?

Please list any skin diseases:

Please list any allergies:

Please list any autoimmune diseases:

Please list any medications taken on a daily basis:
Have you consumed drugs or alcohol in the last 24 hours?*
No
Yes
Did you in the last 14 days undergo surgery, in which you were you exposed to radiation, or any other medical interventions?*
No
Yes
Have you ever been allergic to, or have had an allergic reaction to tattooing (tattoo pigments) or any of the related products used in the delivery of tattooing services?*
No
Yes

Please record the cost of your Camouflage Tattoo service.

SECTION 4: USE OF LIKENESS AND RELEASE (PHOTOS & VIDEO)

By participating as a client, I permit, authorize, and license the technician(s) and the Business and their employees, officers, directors, contractors, and agents of each and all of them ("Authorized Persons"), to display, publicly perform, exhibit, transmit, broadcast, reproduce, record, photograph, digitize, modify, alter, edit, adapt, create derivative works, exploit, sell, rent, license, otherwise use, and permit others to use my image, likeness, and appearance, and all materials created by or on behalf of my participation that incorporates any of the foregoing ("Materials") on a perpetual basis throughout the world and in any medium or format whatsoever now existing or hereafter created for publicity, advertising, and marketing purposes, and for any purpose they deem reasonably appropriate, without further consent from or royalty, payment, or other compensation to me. I agree that all right, title and interest in and to all such Materials is the exclusive property of the Authorized Persons. I understand that the Authorized Persons may keep or use the Materials now and in the future. I understand that although the Authorized Persons will endeavour to use my image, likeness, and appearance in accordance with standards of good judgment, they cannot warrant or guarantee that any further dissemination of my image, likeness, and appearance will be subject to their supervision or control. Accordingly, I release the Authorized Persons from all liability or responsibility that may arise from the acts that I have authorized or consented to in this Section.*
No
Yes

SECTION 5: GENERAL RELEASE AND WAIVER

I recognize and acknowledge that there are certain risks of personal injury or property damage related to my participation as a client, and I voluntarily agree to fully assume all of these risks, regardless of severity, that I may sustain as a result of participating in any and all activities connected with or associated with the application by the technician of brow lamination and/or colouring to my eyebrows using the Brow Lamination technique, including, but not limited to, injuries, damages and losses arising out of negligent supervision, tort, contract, products, or any other theory of recovery. I, for myself and my heirs, assigns, personal representatives, and next of kin, expressly waive and release any and all claims, now known or hereafter known, against the Business, and their employees, officers, directors, contractors, and agents of each and all of them (collectively, "Releasees"), on account of personal injury or property damage arising out of or attributable to my participation as a client, whether arising out of the negligence of any Releasees or otherwise. I covenant not to make or bring any such claim against any Releasee, and forever release and discharge all Releasees from liability under such claims. All matters arising out of or relating to this waiver and release shall be governed by and construed in accordance with the internal laws of Ontario without giving effect to any choice or conflict of law provision or rule (whether of Ontario or any other jurisdiction). Any claim or cause of action arising under this waiver and release may be brought only in the federal and Provincial courts located in Ontario, Canada and I consent to the exclusive jurisdiction of such courts. I understand that this waiver and release is intended to be as broad and inclusive as permitted by law and that if any portion hereof is held invalid, I agree that the balance shall continue in full legal force and effect. I further agree that if this waiver and release is not valid in Ontario, Canada, it shall be construed as a covenant not to sue anytime, anywhere and for any reason. *
I Agree
I HAVE READ THE INFORMATION IN THIS WAIVER THOROUGHLY. I UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT. I HAVE THE CAPACITY TO PROVIDE INFORMED CONSENT AND I AM SIGNING THIS WAIVER AND RELEASE FREELY AND VOLUNTARILY. *
I Agree

COVID-19 Screening Questions

If you have travelled outside of Canada (or have been exposed to someone who a confirmed case of COVID-19) within 14 days of your scheduled appointment you must have subjected yourself to a period of self-isolation and quarantine before you are eligible to receive any services at Ivonne Sanchez Beauty.

Have you travelled outside of Canada within the past 14 days of the scheduled day of treatment?*
No
Yes
If you have travelled outside of Canada (or have been in contact with someone with COVID-19) within the past 14 days have you developed a cough, fever, or experienced difficulty breathing?*
No
Yes
Click to customize question*
No
Yes
For personal services such as those offered at Ivonne Sanchez Beauty the nature of work performed requires close contact with colleagues and customers (i.e. within 2 metres). These interactions, as well as the need to touch work surfaces and equipment could increase the likelihood that we or you could come in contact with the virus. *
I Agree
Third Client's Name

First Name*

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

Age

How you found us:
Area(s) To Be Treated / Treatment Procedure (Please Check): *
Arms
Breasts
Aereola
Thigh
Other

If other:

SECTION 3: HEALTH QUESTIONNAIRE

To perform the Camouflage Tattoo procedure in a safe manner, please answer the following health questions truthfully. We will keep all information disclosed in a confidential manner and will use it only for purposes of determining whether you are an ideal candidate for this procedure.

Are you over the age of 18? (You must be 18 years of age to receive our services).*
No
Yes
Have you had a chemical or laser peel?*
No
Yes
Are you currently using Retin-A or "Alpha Hydroxy" skin care products? (If so, avoid use for 1 month following procedure)*
No
Yes
Are you allergic to topical antibiotic numbing creams or desensitizers?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you*
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes
Do you have any allergies? If yes, list in space provided at the end of the form.*
No
Yes
Are you currently taking medication for high or low blood pressure?*
No
Yes
Will you work out on the day of treatment?*
No
Yes

Botox (date of last treatment)

What is the date of service: *
Do you currently have and/or have had in the past, and/or have you experienced any of the following:
Hemophilia
Do you have problems with healing of wounds?
Diabetes mellitus (diabetes)
Hepatitis A, B, C, D, E, F
HIV +
Eczema
Are you prone to herpes?
Infectious diseases / high fever
Epilepsy
Cardiovascular problems
Do you have a pacemaker?
Are you taking medication for blood thinning (anticoagulants)?
Are you pregnant?
Are you breastfeeding?
Have you received tattoo, micropigmentation or camouflage tattoo in the past 6 months on the areas to be treated?

Please list any skin diseases:

Please list any allergies:

Please list any autoimmune diseases:

Please list any medications taken on a daily basis:
Have you consumed drugs or alcohol in the last 24 hours?*
No
Yes
Did you in the last 14 days undergo surgery, in which you were you exposed to radiation, or any other medical interventions?*
No
Yes
Have you ever been allergic to, or have had an allergic reaction to tattooing (tattoo pigments) or any of the related products used in the delivery of tattooing services?*
No
Yes

Please record the cost of your Camouflage Tattoo service.

SECTION 4: USE OF LIKENESS AND RELEASE (PHOTOS & VIDEO)

By participating as a client, I permit, authorize, and license the technician(s) and the Business and their employees, officers, directors, contractors, and agents of each and all of them ("Authorized Persons"), to display, publicly perform, exhibit, transmit, broadcast, reproduce, record, photograph, digitize, modify, alter, edit, adapt, create derivative works, exploit, sell, rent, license, otherwise use, and permit others to use my image, likeness, and appearance, and all materials created by or on behalf of my participation that incorporates any of the foregoing ("Materials") on a perpetual basis throughout the world and in any medium or format whatsoever now existing or hereafter created for publicity, advertising, and marketing purposes, and for any purpose they deem reasonably appropriate, without further consent from or royalty, payment, or other compensation to me. I agree that all right, title and interest in and to all such Materials is the exclusive property of the Authorized Persons. I understand that the Authorized Persons may keep or use the Materials now and in the future. I understand that although the Authorized Persons will endeavour to use my image, likeness, and appearance in accordance with standards of good judgment, they cannot warrant or guarantee that any further dissemination of my image, likeness, and appearance will be subject to their supervision or control. Accordingly, I release the Authorized Persons from all liability or responsibility that may arise from the acts that I have authorized or consented to in this Section.*
No
Yes

SECTION 5: GENERAL RELEASE AND WAIVER

I recognize and acknowledge that there are certain risks of personal injury or property damage related to my participation as a client, and I voluntarily agree to fully assume all of these risks, regardless of severity, that I may sustain as a result of participating in any and all activities connected with or associated with the application by the technician of brow lamination and/or colouring to my eyebrows using the Brow Lamination technique, including, but not limited to, injuries, damages and losses arising out of negligent supervision, tort, contract, products, or any other theory of recovery. I, for myself and my heirs, assigns, personal representatives, and next of kin, expressly waive and release any and all claims, now known or hereafter known, against the Business, and their employees, officers, directors, contractors, and agents of each and all of them (collectively, "Releasees"), on account of personal injury or property damage arising out of or attributable to my participation as a client, whether arising out of the negligence of any Releasees or otherwise. I covenant not to make or bring any such claim against any Releasee, and forever release and discharge all Releasees from liability under such claims. All matters arising out of or relating to this waiver and release shall be governed by and construed in accordance with the internal laws of Ontario without giving effect to any choice or conflict of law provision or rule (whether of Ontario or any other jurisdiction). Any claim or cause of action arising under this waiver and release may be brought only in the federal and Provincial courts located in Ontario, Canada and I consent to the exclusive jurisdiction of such courts. I understand that this waiver and release is intended to be as broad and inclusive as permitted by law and that if any portion hereof is held invalid, I agree that the balance shall continue in full legal force and effect. I further agree that if this waiver and release is not valid in Ontario, Canada, it shall be construed as a covenant not to sue anytime, anywhere and for any reason. *
I Agree
I HAVE READ THE INFORMATION IN THIS WAIVER THOROUGHLY. I UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT. I HAVE THE CAPACITY TO PROVIDE INFORMED CONSENT AND I AM SIGNING THIS WAIVER AND RELEASE FREELY AND VOLUNTARILY. *
I Agree

COVID-19 Screening Questions

If you have travelled outside of Canada (or have been exposed to someone who a confirmed case of COVID-19) within 14 days of your scheduled appointment you must have subjected yourself to a period of self-isolation and quarantine before you are eligible to receive any services at Ivonne Sanchez Beauty.

Have you travelled outside of Canada within the past 14 days of the scheduled day of treatment?*
No
Yes
If you have travelled outside of Canada (or have been in contact with someone with COVID-19) within the past 14 days have you developed a cough, fever, or experienced difficulty breathing?*
No
Yes
Click to customize question*
No
Yes
For personal services such as those offered at Ivonne Sanchez Beauty the nature of work performed requires close contact with colleagues and customers (i.e. within 2 metres). These interactions, as well as the need to touch work surfaces and equipment could increase the likelihood that we or you could come in contact with the virus. *
I Agree
Fourth Client's Name

First Name*

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

Age

How you found us:
Area(s) To Be Treated / Treatment Procedure (Please Check): *
Arms
Breasts
Aereola
Thigh
Other

If other:

SECTION 3: HEALTH QUESTIONNAIRE

To perform the Camouflage Tattoo procedure in a safe manner, please answer the following health questions truthfully. We will keep all information disclosed in a confidential manner and will use it only for purposes of determining whether you are an ideal candidate for this procedure.

Are you over the age of 18? (You must be 18 years of age to receive our services).*
No
Yes
Have you had a chemical or laser peel?*
No
Yes
Are you currently using Retin-A or "Alpha Hydroxy" skin care products? (If so, avoid use for 1 month following procedure)*
No
Yes
Are you allergic to topical antibiotic numbing creams or desensitizers?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you*
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes
Do you have any allergies? If yes, list in space provided at the end of the form.*
No
Yes
Are you currently taking medication for high or low blood pressure?*
No
Yes
Will you work out on the day of treatment?*
No
Yes

Botox (date of last treatment)

What is the date of service: *
Do you currently have and/or have had in the past, and/or have you experienced any of the following:
Hemophilia
Do you have problems with healing of wounds?
Diabetes mellitus (diabetes)
Hepatitis A, B, C, D, E, F
HIV +
Eczema
Are you prone to herpes?
Infectious diseases / high fever
Epilepsy
Cardiovascular problems
Do you have a pacemaker?
Are you taking medication for blood thinning (anticoagulants)?
Are you pregnant?
Are you breastfeeding?
Have you received tattoo, micropigmentation or camouflage tattoo in the past 6 months on the areas to be treated?

Please list any skin diseases:

Please list any allergies:

Please list any autoimmune diseases:

Please list any medications taken on a daily basis:
Have you consumed drugs or alcohol in the last 24 hours?*
No
Yes
Did you in the last 14 days undergo surgery, in which you were you exposed to radiation, or any other medical interventions?*
No
Yes
Have you ever been allergic to, or have had an allergic reaction to tattooing (tattoo pigments) or any of the related products used in the delivery of tattooing services?*
No
Yes

Please record the cost of your Camouflage Tattoo service.

SECTION 4: USE OF LIKENESS AND RELEASE (PHOTOS & VIDEO)

By participating as a client, I permit, authorize, and license the technician(s) and the Business and their employees, officers, directors, contractors, and agents of each and all of them ("Authorized Persons"), to display, publicly perform, exhibit, transmit, broadcast, reproduce, record, photograph, digitize, modify, alter, edit, adapt, create derivative works, exploit, sell, rent, license, otherwise use, and permit others to use my image, likeness, and appearance, and all materials created by or on behalf of my participation that incorporates any of the foregoing ("Materials") on a perpetual basis throughout the world and in any medium or format whatsoever now existing or hereafter created for publicity, advertising, and marketing purposes, and for any purpose they deem reasonably appropriate, without further consent from or royalty, payment, or other compensation to me. I agree that all right, title and interest in and to all such Materials is the exclusive property of the Authorized Persons. I understand that the Authorized Persons may keep or use the Materials now and in the future. I understand that although the Authorized Persons will endeavour to use my image, likeness, and appearance in accordance with standards of good judgment, they cannot warrant or guarantee that any further dissemination of my image, likeness, and appearance will be subject to their supervision or control. Accordingly, I release the Authorized Persons from all liability or responsibility that may arise from the acts that I have authorized or consented to in this Section.*
No
Yes

SECTION 5: GENERAL RELEASE AND WAIVER

I recognize and acknowledge that there are certain risks of personal injury or property damage related to my participation as a client, and I voluntarily agree to fully assume all of these risks, regardless of severity, that I may sustain as a result of participating in any and all activities connected with or associated with the application by the technician of brow lamination and/or colouring to my eyebrows using the Brow Lamination technique, including, but not limited to, injuries, damages and losses arising out of negligent supervision, tort, contract, products, or any other theory of recovery. I, for myself and my heirs, assigns, personal representatives, and next of kin, expressly waive and release any and all claims, now known or hereafter known, against the Business, and their employees, officers, directors, contractors, and agents of each and all of them (collectively, "Releasees"), on account of personal injury or property damage arising out of or attributable to my participation as a client, whether arising out of the negligence of any Releasees or otherwise. I covenant not to make or bring any such claim against any Releasee, and forever release and discharge all Releasees from liability under such claims. All matters arising out of or relating to this waiver and release shall be governed by and construed in accordance with the internal laws of Ontario without giving effect to any choice or conflict of law provision or rule (whether of Ontario or any other jurisdiction). Any claim or cause of action arising under this waiver and release may be brought only in the federal and Provincial courts located in Ontario, Canada and I consent to the exclusive jurisdiction of such courts. I understand that this waiver and release is intended to be as broad and inclusive as permitted by law and that if any portion hereof is held invalid, I agree that the balance shall continue in full legal force and effect. I further agree that if this waiver and release is not valid in Ontario, Canada, it shall be construed as a covenant not to sue anytime, anywhere and for any reason. *
I Agree
I HAVE READ THE INFORMATION IN THIS WAIVER THOROUGHLY. I UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT. I HAVE THE CAPACITY TO PROVIDE INFORMED CONSENT AND I AM SIGNING THIS WAIVER AND RELEASE FREELY AND VOLUNTARILY. *
I Agree

COVID-19 Screening Questions

If you have travelled outside of Canada (or have been exposed to someone who a confirmed case of COVID-19) within 14 days of your scheduled appointment you must have subjected yourself to a period of self-isolation and quarantine before you are eligible to receive any services at Ivonne Sanchez Beauty.

Have you travelled outside of Canada within the past 14 days of the scheduled day of treatment?*
No
Yes
If you have travelled outside of Canada (or have been in contact with someone with COVID-19) within the past 14 days have you developed a cough, fever, or experienced difficulty breathing?*
No
Yes
Click to customize question*
No
Yes
For personal services such as those offered at Ivonne Sanchez Beauty the nature of work performed requires close contact with colleagues and customers (i.e. within 2 metres). These interactions, as well as the need to touch work surfaces and equipment could increase the likelihood that we or you could come in contact with the virus. *
I Agree
Fifth Client's Name

First Name*

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

Age

How you found us:
Area(s) To Be Treated / Treatment Procedure (Please Check): *
Arms
Breasts
Aereola
Thigh
Other

If other:

SECTION 3: HEALTH QUESTIONNAIRE

To perform the Camouflage Tattoo procedure in a safe manner, please answer the following health questions truthfully. We will keep all information disclosed in a confidential manner and will use it only for purposes of determining whether you are an ideal candidate for this procedure.

Are you over the age of 18? (You must be 18 years of age to receive our services).*
No
Yes
Have you had a chemical or laser peel?*
No
Yes
Are you currently using Retin-A or "Alpha Hydroxy" skin care products? (If so, avoid use for 1 month following procedure)*
No
Yes
Are you allergic to topical antibiotic numbing creams or desensitizers?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you*
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes
Do you have any allergies? If yes, list in space provided at the end of the form.*
No
Yes
Are you currently taking medication for high or low blood pressure?*
No
Yes
Will you work out on the day of treatment?*
No
Yes

Botox (date of last treatment)

What is the date of service: *
Do you currently have and/or have had in the past, and/or have you experienced any of the following:
Hemophilia
Do you have problems with healing of wounds?
Diabetes mellitus (diabetes)
Hepatitis A, B, C, D, E, F
HIV +
Eczema
Are you prone to herpes?
Infectious diseases / high fever
Epilepsy
Cardiovascular problems
Do you have a pacemaker?
Are you taking medication for blood thinning (anticoagulants)?
Are you pregnant?
Are you breastfeeding?
Have you received tattoo, micropigmentation or camouflage tattoo in the past 6 months on the areas to be treated?

Please list any skin diseases:

Please list any allergies:

Please list any autoimmune diseases:

Please list any medications taken on a daily basis:
Have you consumed drugs or alcohol in the last 24 hours?*
No
Yes
Did you in the last 14 days undergo surgery, in which you were you exposed to radiation, or any other medical interventions?*
No
Yes
Have you ever been allergic to, or have had an allergic reaction to tattooing (tattoo pigments) or any of the related products used in the delivery of tattooing services?*
No
Yes

Please record the cost of your Camouflage Tattoo service.

SECTION 4: USE OF LIKENESS AND RELEASE (PHOTOS & VIDEO)

By participating as a client, I permit, authorize, and license the technician(s) and the Business and their employees, officers, directors, contractors, and agents of each and all of them ("Authorized Persons"), to display, publicly perform, exhibit, transmit, broadcast, reproduce, record, photograph, digitize, modify, alter, edit, adapt, create derivative works, exploit, sell, rent, license, otherwise use, and permit others to use my image, likeness, and appearance, and all materials created by or on behalf of my participation that incorporates any of the foregoing ("Materials") on a perpetual basis throughout the world and in any medium or format whatsoever now existing or hereafter created for publicity, advertising, and marketing purposes, and for any purpose they deem reasonably appropriate, without further consent from or royalty, payment, or other compensation to me. I agree that all right, title and interest in and to all such Materials is the exclusive property of the Authorized Persons. I understand that the Authorized Persons may keep or use the Materials now and in the future. I understand that although the Authorized Persons will endeavour to use my image, likeness, and appearance in accordance with standards of good judgment, they cannot warrant or guarantee that any further dissemination of my image, likeness, and appearance will be subject to their supervision or control. Accordingly, I release the Authorized Persons from all liability or responsibility that may arise from the acts that I have authorized or consented to in this Section.*
No
Yes

SECTION 5: GENERAL RELEASE AND WAIVER

I recognize and acknowledge that there are certain risks of personal injury or property damage related to my participation as a client, and I voluntarily agree to fully assume all of these risks, regardless of severity, that I may sustain as a result of participating in any and all activities connected with or associated with the application by the technician of brow lamination and/or colouring to my eyebrows using the Brow Lamination technique, including, but not limited to, injuries, damages and losses arising out of negligent supervision, tort, contract, products, or any other theory of recovery. I, for myself and my heirs, assigns, personal representatives, and next of kin, expressly waive and release any and all claims, now known or hereafter known, against the Business, and their employees, officers, directors, contractors, and agents of each and all of them (collectively, "Releasees"), on account of personal injury or property damage arising out of or attributable to my participation as a client, whether arising out of the negligence of any Releasees or otherwise. I covenant not to make or bring any such claim against any Releasee, and forever release and discharge all Releasees from liability under such claims. All matters arising out of or relating to this waiver and release shall be governed by and construed in accordance with the internal laws of Ontario without giving effect to any choice or conflict of law provision or rule (whether of Ontario or any other jurisdiction). Any claim or cause of action arising under this waiver and release may be brought only in the federal and Provincial courts located in Ontario, Canada and I consent to the exclusive jurisdiction of such courts. I understand that this waiver and release is intended to be as broad and inclusive as permitted by law and that if any portion hereof is held invalid, I agree that the balance shall continue in full legal force and effect. I further agree that if this waiver and release is not valid in Ontario, Canada, it shall be construed as a covenant not to sue anytime, anywhere and for any reason. *
I Agree
I HAVE READ THE INFORMATION IN THIS WAIVER THOROUGHLY. I UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT. I HAVE THE CAPACITY TO PROVIDE INFORMED CONSENT AND I AM SIGNING THIS WAIVER AND RELEASE FREELY AND VOLUNTARILY. *
I Agree

COVID-19 Screening Questions

If you have travelled outside of Canada (or have been exposed to someone who a confirmed case of COVID-19) within 14 days of your scheduled appointment you must have subjected yourself to a period of self-isolation and quarantine before you are eligible to receive any services at Ivonne Sanchez Beauty.

Have you travelled outside of Canada within the past 14 days of the scheduled day of treatment?*
No
Yes
If you have travelled outside of Canada (or have been in contact with someone with COVID-19) within the past 14 days have you developed a cough, fever, or experienced difficulty breathing?*
No
Yes
Click to customize question*
No
Yes
For personal services such as those offered at Ivonne Sanchez Beauty the nature of work performed requires close contact with colleagues and customers (i.e. within 2 metres). These interactions, as well as the need to touch work surfaces and equipment could increase the likelihood that we or you could come in contact with the virus. *
I Agree
Sixth Client's Name

First Name*

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

Age

How you found us:
Area(s) To Be Treated / Treatment Procedure (Please Check): *
Arms
Breasts
Aereola
Thigh
Other

If other:

SECTION 3: HEALTH QUESTIONNAIRE

To perform the Camouflage Tattoo procedure in a safe manner, please answer the following health questions truthfully. We will keep all information disclosed in a confidential manner and will use it only for purposes of determining whether you are an ideal candidate for this procedure.

Are you over the age of 18? (You must be 18 years of age to receive our services).*
No
Yes
Have you had a chemical or laser peel?*
No
Yes
Are you currently using Retin-A or "Alpha Hydroxy" skin care products? (If so, avoid use for 1 month following procedure)*
No
Yes
Are you allergic to topical antibiotic numbing creams or desensitizers?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you*
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes
Do you have any allergies? If yes, list in space provided at the end of the form.*
No
Yes
Are you currently taking medication for high or low blood pressure?*
No
Yes
Will you work out on the day of treatment?*
No
Yes

Botox (date of last treatment)

What is the date of service: *
Do you currently have and/or have had in the past, and/or have you experienced any of the following:
Hemophilia
Do you have problems with healing of wounds?
Diabetes mellitus (diabetes)
Hepatitis A, B, C, D, E, F
HIV +
Eczema
Are you prone to herpes?
Infectious diseases / high fever
Epilepsy
Cardiovascular problems
Do you have a pacemaker?
Are you taking medication for blood thinning (anticoagulants)?
Are you pregnant?
Are you breastfeeding?
Have you received tattoo, micropigmentation or camouflage tattoo in the past 6 months on the areas to be treated?

Please list any skin diseases:

Please list any allergies:

Please list any autoimmune diseases:

Please list any medications taken on a daily basis:
Have you consumed drugs or alcohol in the last 24 hours?*
No
Yes
Did you in the last 14 days undergo surgery, in which you were you exposed to radiation, or any other medical interventions?*
No
Yes
Have you ever been allergic to, or have had an allergic reaction to tattooing (tattoo pigments) or any of the related products used in the delivery of tattooing services?*
No
Yes

Please record the cost of your Camouflage Tattoo service.

SECTION 4: USE OF LIKENESS AND RELEASE (PHOTOS & VIDEO)

By participating as a client, I permit, authorize, and license the technician(s) and the Business and their employees, officers, directors, contractors, and agents of each and all of them ("Authorized Persons"), to display, publicly perform, exhibit, transmit, broadcast, reproduce, record, photograph, digitize, modify, alter, edit, adapt, create derivative works, exploit, sell, rent, license, otherwise use, and permit others to use my image, likeness, and appearance, and all materials created by or on behalf of my participation that incorporates any of the foregoing ("Materials") on a perpetual basis throughout the world and in any medium or format whatsoever now existing or hereafter created for publicity, advertising, and marketing purposes, and for any purpose they deem reasonably appropriate, without further consent from or royalty, payment, or other compensation to me. I agree that all right, title and interest in and to all such Materials is the exclusive property of the Authorized Persons. I understand that the Authorized Persons may keep or use the Materials now and in the future. I understand that although the Authorized Persons will endeavour to use my image, likeness, and appearance in accordance with standards of good judgment, they cannot warrant or guarantee that any further dissemination of my image, likeness, and appearance will be subject to their supervision or control. Accordingly, I release the Authorized Persons from all liability or responsibility that may arise from the acts that I have authorized or consented to in this Section.*
No
Yes

SECTION 5: GENERAL RELEASE AND WAIVER

I recognize and acknowledge that there are certain risks of personal injury or property damage related to my participation as a client, and I voluntarily agree to fully assume all of these risks, regardless of severity, that I may sustain as a result of participating in any and all activities connected with or associated with the application by the technician of brow lamination and/or colouring to my eyebrows using the Brow Lamination technique, including, but not limited to, injuries, damages and losses arising out of negligent supervision, tort, contract, products, or any other theory of recovery. I, for myself and my heirs, assigns, personal representatives, and next of kin, expressly waive and release any and all claims, now known or hereafter known, against the Business, and their employees, officers, directors, contractors, and agents of each and all of them (collectively, "Releasees"), on account of personal injury or property damage arising out of or attributable to my participation as a client, whether arising out of the negligence of any Releasees or otherwise. I covenant not to make or bring any such claim against any Releasee, and forever release and discharge all Releasees from liability under such claims. All matters arising out of or relating to this waiver and release shall be governed by and construed in accordance with the internal laws of Ontario without giving effect to any choice or conflict of law provision or rule (whether of Ontario or any other jurisdiction). Any claim or cause of action arising under this waiver and release may be brought only in the federal and Provincial courts located in Ontario, Canada and I consent to the exclusive jurisdiction of such courts. I understand that this waiver and release is intended to be as broad and inclusive as permitted by law and that if any portion hereof is held invalid, I agree that the balance shall continue in full legal force and effect. I further agree that if this waiver and release is not valid in Ontario, Canada, it shall be construed as a covenant not to sue anytime, anywhere and for any reason. *
I Agree
I HAVE READ THE INFORMATION IN THIS WAIVER THOROUGHLY. I UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT. I HAVE THE CAPACITY TO PROVIDE INFORMED CONSENT AND I AM SIGNING THIS WAIVER AND RELEASE FREELY AND VOLUNTARILY. *
I Agree

COVID-19 Screening Questions

If you have travelled outside of Canada (or have been exposed to someone who a confirmed case of COVID-19) within 14 days of your scheduled appointment you must have subjected yourself to a period of self-isolation and quarantine before you are eligible to receive any services at Ivonne Sanchez Beauty.

Have you travelled outside of Canada within the past 14 days of the scheduled day of treatment?*
No
Yes
If you have travelled outside of Canada (or have been in contact with someone with COVID-19) within the past 14 days have you developed a cough, fever, or experienced difficulty breathing?*
No
Yes
Click to customize question*
No
Yes
For personal services such as those offered at Ivonne Sanchez Beauty the nature of work performed requires close contact with colleagues and customers (i.e. within 2 metres). These interactions, as well as the need to touch work surfaces and equipment could increase the likelihood that we or you could come in contact with the virus. *
I Agree
Seventh Client's Name

First Name*

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

Age

How you found us:
Area(s) To Be Treated / Treatment Procedure (Please Check): *
Arms
Breasts
Aereola
Thigh
Other

If other:

SECTION 3: HEALTH QUESTIONNAIRE

To perform the Camouflage Tattoo procedure in a safe manner, please answer the following health questions truthfully. We will keep all information disclosed in a confidential manner and will use it only for purposes of determining whether you are an ideal candidate for this procedure.

Are you over the age of 18? (You must be 18 years of age to receive our services).*
No
Yes
Have you had a chemical or laser peel?*
No
Yes
Are you currently using Retin-A or "Alpha Hydroxy" skin care products? (If so, avoid use for 1 month following procedure)*
No
Yes
Are you allergic to topical antibiotic numbing creams or desensitizers?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you*
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes
Do you have any allergies? If yes, list in space provided at the end of the form.*
No
Yes
Are you currently taking medication for high or low blood pressure?*
No
Yes
Will you work out on the day of treatment?*
No
Yes

Botox (date of last treatment)

What is the date of service: *
Do you currently have and/or have had in the past, and/or have you experienced any of the following:
Hemophilia
Do you have problems with healing of wounds?
Diabetes mellitus (diabetes)
Hepatitis A, B, C, D, E, F
HIV +
Eczema
Are you prone to herpes?
Infectious diseases / high fever
Epilepsy
Cardiovascular problems
Do you have a pacemaker?
Are you taking medication for blood thinning (anticoagulants)?
Are you pregnant?
Are you breastfeeding?
Have you received tattoo, micropigmentation or camouflage tattoo in the past 6 months on the areas to be treated?

Please list any skin diseases:

Please list any allergies:

Please list any autoimmune diseases:

Please list any medications taken on a daily basis:
Have you consumed drugs or alcohol in the last 24 hours?*
No
Yes
Did you in the last 14 days undergo surgery, in which you were you exposed to radiation, or any other medical interventions?*
No
Yes
Have you ever been allergic to, or have had an allergic reaction to tattooing (tattoo pigments) or any of the related products used in the delivery of tattooing services?*
No
Yes

Please record the cost of your Camouflage Tattoo service.

SECTION 4: USE OF LIKENESS AND RELEASE (PHOTOS & VIDEO)

By participating as a client, I permit, authorize, and license the technician(s) and the Business and their employees, officers, directors, contractors, and agents of each and all of them ("Authorized Persons"), to display, publicly perform, exhibit, transmit, broadcast, reproduce, record, photograph, digitize, modify, alter, edit, adapt, create derivative works, exploit, sell, rent, license, otherwise use, and permit others to use my image, likeness, and appearance, and all materials created by or on behalf of my participation that incorporates any of the foregoing ("Materials") on a perpetual basis throughout the world and in any medium or format whatsoever now existing or hereafter created for publicity, advertising, and marketing purposes, and for any purpose they deem reasonably appropriate, without further consent from or royalty, payment, or other compensation to me. I agree that all right, title and interest in and to all such Materials is the exclusive property of the Authorized Persons. I understand that the Authorized Persons may keep or use the Materials now and in the future. I understand that although the Authorized Persons will endeavour to use my image, likeness, and appearance in accordance with standards of good judgment, they cannot warrant or guarantee that any further dissemination of my image, likeness, and appearance will be subject to their supervision or control. Accordingly, I release the Authorized Persons from all liability or responsibility that may arise from the acts that I have authorized or consented to in this Section.*
No
Yes

SECTION 5: GENERAL RELEASE AND WAIVER

I recognize and acknowledge that there are certain risks of personal injury or property damage related to my participation as a client, and I voluntarily agree to fully assume all of these risks, regardless of severity, that I may sustain as a result of participating in any and all activities connected with or associated with the application by the technician of brow lamination and/or colouring to my eyebrows using the Brow Lamination technique, including, but not limited to, injuries, damages and losses arising out of negligent supervision, tort, contract, products, or any other theory of recovery. I, for myself and my heirs, assigns, personal representatives, and next of kin, expressly waive and release any and all claims, now known or hereafter known, against the Business, and their employees, officers, directors, contractors, and agents of each and all of them (collectively, "Releasees"), on account of personal injury or property damage arising out of or attributable to my participation as a client, whether arising out of the negligence of any Releasees or otherwise. I covenant not to make or bring any such claim against any Releasee, and forever release and discharge all Releasees from liability under such claims. All matters arising out of or relating to this waiver and release shall be governed by and construed in accordance with the internal laws of Ontario without giving effect to any choice or conflict of law provision or rule (whether of Ontario or any other jurisdiction). Any claim or cause of action arising under this waiver and release may be brought only in the federal and Provincial courts located in Ontario, Canada and I consent to the exclusive jurisdiction of such courts. I understand that this waiver and release is intended to be as broad and inclusive as permitted by law and that if any portion hereof is held invalid, I agree that the balance shall continue in full legal force and effect. I further agree that if this waiver and release is not valid in Ontario, Canada, it shall be construed as a covenant not to sue anytime, anywhere and for any reason. *
I Agree
I HAVE READ THE INFORMATION IN THIS WAIVER THOROUGHLY. I UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT. I HAVE THE CAPACITY TO PROVIDE INFORMED CONSENT AND I AM SIGNING THIS WAIVER AND RELEASE FREELY AND VOLUNTARILY. *
I Agree

COVID-19 Screening Questions

If you have travelled outside of Canada (or have been exposed to someone who a confirmed case of COVID-19) within 14 days of your scheduled appointment you must have subjected yourself to a period of self-isolation and quarantine before you are eligible to receive any services at Ivonne Sanchez Beauty.

Have you travelled outside of Canada within the past 14 days of the scheduled day of treatment?*
No
Yes
If you have travelled outside of Canada (or have been in contact with someone with COVID-19) within the past 14 days have you developed a cough, fever, or experienced difficulty breathing?*
No
Yes
Click to customize question*
No
Yes
For personal services such as those offered at Ivonne Sanchez Beauty the nature of work performed requires close contact with colleagues and customers (i.e. within 2 metres). These interactions, as well as the need to touch work surfaces and equipment could increase the likelihood that we or you could come in contact with the virus. *
I Agree
Eighth Client's Name

First Name*

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

Age

How you found us:
Area(s) To Be Treated / Treatment Procedure (Please Check): *
Arms
Breasts
Aereola
Thigh
Other

If other:

SECTION 3: HEALTH QUESTIONNAIRE

To perform the Camouflage Tattoo procedure in a safe manner, please answer the following health questions truthfully. We will keep all information disclosed in a confidential manner and will use it only for purposes of determining whether you are an ideal candidate for this procedure.

Are you over the age of 18? (You must be 18 years of age to receive our services).*
No
Yes
Have you had a chemical or laser peel?*
No
Yes
Are you currently using Retin-A or "Alpha Hydroxy" skin care products? (If so, avoid use for 1 month following procedure)*
No
Yes
Are you allergic to topical antibiotic numbing creams or desensitizers?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you*
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes
Do you have any allergies? If yes, list in space provided at the end of the form.*
No
Yes
Are you currently taking medication for high or low blood pressure?*
No
Yes
Will you work out on the day of treatment?*
No
Yes

Botox (date of last treatment)

What is the date of service: *
Do you currently have and/or have had in the past, and/or have you experienced any of the following:
Hemophilia
Do you have problems with healing of wounds?
Diabetes mellitus (diabetes)
Hepatitis A, B, C, D, E, F
HIV +
Eczema
Are you prone to herpes?
Infectious diseases / high fever
Epilepsy
Cardiovascular problems
Do you have a pacemaker?
Are you taking medication for blood thinning (anticoagulants)?
Are you pregnant?
Are you breastfeeding?
Have you received tattoo, micropigmentation or camouflage tattoo in the past 6 months on the areas to be treated?

Please list any skin diseases:

Please list any allergies:

Please list any autoimmune diseases:

Please list any medications taken on a daily basis:
Have you consumed drugs or alcohol in the last 24 hours?*
No
Yes
Did you in the last 14 days undergo surgery, in which you were you exposed to radiation, or any other medical interventions?*
No
Yes
Have you ever been allergic to, or have had an allergic reaction to tattooing (tattoo pigments) or any of the related products used in the delivery of tattooing services?*
No
Yes

Please record the cost of your Camouflage Tattoo service.

SECTION 4: USE OF LIKENESS AND RELEASE (PHOTOS & VIDEO)

By participating as a client, I permit, authorize, and license the technician(s) and the Business and their employees, officers, directors, contractors, and agents of each and all of them ("Authorized Persons"), to display, publicly perform, exhibit, transmit, broadcast, reproduce, record, photograph, digitize, modify, alter, edit, adapt, create derivative works, exploit, sell, rent, license, otherwise use, and permit others to use my image, likeness, and appearance, and all materials created by or on behalf of my participation that incorporates any of the foregoing ("Materials") on a perpetual basis throughout the world and in any medium or format whatsoever now existing or hereafter created for publicity, advertising, and marketing purposes, and for any purpose they deem reasonably appropriate, without further consent from or royalty, payment, or other compensation to me. I agree that all right, title and interest in and to all such Materials is the exclusive property of the Authorized Persons. I understand that the Authorized Persons may keep or use the Materials now and in the future. I understand that although the Authorized Persons will endeavour to use my image, likeness, and appearance in accordance with standards of good judgment, they cannot warrant or guarantee that any further dissemination of my image, likeness, and appearance will be subject to their supervision or control. Accordingly, I release the Authorized Persons from all liability or responsibility that may arise from the acts that I have authorized or consented to in this Section.*
No
Yes

SECTION 5: GENERAL RELEASE AND WAIVER

I recognize and acknowledge that there are certain risks of personal injury or property damage related to my participation as a client, and I voluntarily agree to fully assume all of these risks, regardless of severity, that I may sustain as a result of participating in any and all activities connected with or associated with the application by the technician of brow lamination and/or colouring to my eyebrows using the Brow Lamination technique, including, but not limited to, injuries, damages and losses arising out of negligent supervision, tort, contract, products, or any other theory of recovery. I, for myself and my heirs, assigns, personal representatives, and next of kin, expressly waive and release any and all claims, now known or hereafter known, against the Business, and their employees, officers, directors, contractors, and agents of each and all of them (collectively, "Releasees"), on account of personal injury or property damage arising out of or attributable to my participation as a client, whether arising out of the negligence of any Releasees or otherwise. I covenant not to make or bring any such claim against any Releasee, and forever release and discharge all Releasees from liability under such claims. All matters arising out of or relating to this waiver and release shall be governed by and construed in accordance with the internal laws of Ontario without giving effect to any choice or conflict of law provision or rule (whether of Ontario or any other jurisdiction). Any claim or cause of action arising under this waiver and release may be brought only in the federal and Provincial courts located in Ontario, Canada and I consent to the exclusive jurisdiction of such courts. I understand that this waiver and release is intended to be as broad and inclusive as permitted by law and that if any portion hereof is held invalid, I agree that the balance shall continue in full legal force and effect. I further agree that if this waiver and release is not valid in Ontario, Canada, it shall be construed as a covenant not to sue anytime, anywhere and for any reason. *
I Agree
I HAVE READ THE INFORMATION IN THIS WAIVER THOROUGHLY. I UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT. I HAVE THE CAPACITY TO PROVIDE INFORMED CONSENT AND I AM SIGNING THIS WAIVER AND RELEASE FREELY AND VOLUNTARILY. *
I Agree

COVID-19 Screening Questions

If you have travelled outside of Canada (or have been exposed to someone who a confirmed case of COVID-19) within 14 days of your scheduled appointment you must have subjected yourself to a period of self-isolation and quarantine before you are eligible to receive any services at Ivonne Sanchez Beauty.

Have you travelled outside of Canada within the past 14 days of the scheduled day of treatment?*
No
Yes
If you have travelled outside of Canada (or have been in contact with someone with COVID-19) within the past 14 days have you developed a cough, fever, or experienced difficulty breathing?*
No
Yes
Click to customize question*
No
Yes
For personal services such as those offered at Ivonne Sanchez Beauty the nature of work performed requires close contact with colleagues and customers (i.e. within 2 metres). These interactions, as well as the need to touch work surfaces and equipment could increase the likelihood that we or you could come in contact with the virus. *
I Agree
Ninth Client's Name

First Name*

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

Age

How you found us:
Area(s) To Be Treated / Treatment Procedure (Please Check): *
Arms
Breasts
Aereola
Thigh
Other

If other:

SECTION 3: HEALTH QUESTIONNAIRE

To perform the Camouflage Tattoo procedure in a safe manner, please answer the following health questions truthfully. We will keep all information disclosed in a confidential manner and will use it only for purposes of determining whether you are an ideal candidate for this procedure.

Are you over the age of 18? (You must be 18 years of age to receive our services).*
No
Yes
Have you had a chemical or laser peel?*
No
Yes
Are you currently using Retin-A or "Alpha Hydroxy" skin care products? (If so, avoid use for 1 month following procedure)*
No
Yes
Are you allergic to topical antibiotic numbing creams or desensitizers?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you*
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes
Do you have any allergies? If yes, list in space provided at the end of the form.*
No
Yes
Are you currently taking medication for high or low blood pressure?*
No
Yes
Will you work out on the day of treatment?*
No
Yes

Botox (date of last treatment)

What is the date of service: *
Do you currently have and/or have had in the past, and/or have you experienced any of the following:
Hemophilia
Do you have problems with healing of wounds?
Diabetes mellitus (diabetes)
Hepatitis A, B, C, D, E, F
HIV +
Eczema
Are you prone to herpes?
Infectious diseases / high fever
Epilepsy
Cardiovascular problems
Do you have a pacemaker?
Are you taking medication for blood thinning (anticoagulants)?
Are you pregnant?
Are you breastfeeding?
Have you received tattoo, micropigmentation or camouflage tattoo in the past 6 months on the areas to be treated?

Please list any skin diseases:

Please list any allergies:

Please list any autoimmune diseases:

Please list any medications taken on a daily basis:
Have you consumed drugs or alcohol in the last 24 hours?*
No
Yes
Did you in the last 14 days undergo surgery, in which you were you exposed to radiation, or any other medical interventions?*
No
Yes
Have you ever been allergic to, or have had an allergic reaction to tattooing (tattoo pigments) or any of the related products used in the delivery of tattooing services?*
No
Yes

Please record the cost of your Camouflage Tattoo service.

SECTION 4: USE OF LIKENESS AND RELEASE (PHOTOS & VIDEO)

By participating as a client, I permit, authorize, and license the technician(s) and the Business and their employees, officers, directors, contractors, and agents of each and all of them ("Authorized Persons"), to display, publicly perform, exhibit, transmit, broadcast, reproduce, record, photograph, digitize, modify, alter, edit, adapt, create derivative works, exploit, sell, rent, license, otherwise use, and permit others to use my image, likeness, and appearance, and all materials created by or on behalf of my participation that incorporates any of the foregoing ("Materials") on a perpetual basis throughout the world and in any medium or format whatsoever now existing or hereafter created for publicity, advertising, and marketing purposes, and for any purpose they deem reasonably appropriate, without further consent from or royalty, payment, or other compensation to me. I agree that all right, title and interest in and to all such Materials is the exclusive property of the Authorized Persons. I understand that the Authorized Persons may keep or use the Materials now and in the future. I understand that although the Authorized Persons will endeavour to use my image, likeness, and appearance in accordance with standards of good judgment, they cannot warrant or guarantee that any further dissemination of my image, likeness, and appearance will be subject to their supervision or control. Accordingly, I release the Authorized Persons from all liability or responsibility that may arise from the acts that I have authorized or consented to in this Section.*
No
Yes

SECTION 5: GENERAL RELEASE AND WAIVER

I recognize and acknowledge that there are certain risks of personal injury or property damage related to my participation as a client, and I voluntarily agree to fully assume all of these risks, regardless of severity, that I may sustain as a result of participating in any and all activities connected with or associated with the application by the technician of brow lamination and/or colouring to my eyebrows using the Brow Lamination technique, including, but not limited to, injuries, damages and losses arising out of negligent supervision, tort, contract, products, or any other theory of recovery. I, for myself and my heirs, assigns, personal representatives, and next of kin, expressly waive and release any and all claims, now known or hereafter known, against the Business, and their employees, officers, directors, contractors, and agents of each and all of them (collectively, "Releasees"), on account of personal injury or property damage arising out of or attributable to my participation as a client, whether arising out of the negligence of any Releasees or otherwise. I covenant not to make or bring any such claim against any Releasee, and forever release and discharge all Releasees from liability under such claims. All matters arising out of or relating to this waiver and release shall be governed by and construed in accordance with the internal laws of Ontario without giving effect to any choice or conflict of law provision or rule (whether of Ontario or any other jurisdiction). Any claim or cause of action arising under this waiver and release may be brought only in the federal and Provincial courts located in Ontario, Canada and I consent to the exclusive jurisdiction of such courts. I understand that this waiver and release is intended to be as broad and inclusive as permitted by law and that if any portion hereof is held invalid, I agree that the balance shall continue in full legal force and effect. I further agree that if this waiver and release is not valid in Ontario, Canada, it shall be construed as a covenant not to sue anytime, anywhere and for any reason. *
I Agree
I HAVE READ THE INFORMATION IN THIS WAIVER THOROUGHLY. I UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT. I HAVE THE CAPACITY TO PROVIDE INFORMED CONSENT AND I AM SIGNING THIS WAIVER AND RELEASE FREELY AND VOLUNTARILY. *
I Agree

COVID-19 Screening Questions

If you have travelled outside of Canada (or have been exposed to someone who a confirmed case of COVID-19) within 14 days of your scheduled appointment you must have subjected yourself to a period of self-isolation and quarantine before you are eligible to receive any services at Ivonne Sanchez Beauty.

Have you travelled outside of Canada within the past 14 days of the scheduled day of treatment?*
No
Yes
If you have travelled outside of Canada (or have been in contact with someone with COVID-19) within the past 14 days have you developed a cough, fever, or experienced difficulty breathing?*
No
Yes
Click to customize question*
No
Yes
For personal services such as those offered at Ivonne Sanchez Beauty the nature of work performed requires close contact with colleagues and customers (i.e. within 2 metres). These interactions, as well as the need to touch work surfaces and equipment could increase the likelihood that we or you could come in contact with the virus. *
I Agree
Tenth Client's Name

First Name*

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

Age

How you found us:
Area(s) To Be Treated / Treatment Procedure (Please Check): *
Arms
Breasts
Aereola
Thigh
Other

If other:

SECTION 3: HEALTH QUESTIONNAIRE

To perform the Camouflage Tattoo procedure in a safe manner, please answer the following health questions truthfully. We will keep all information disclosed in a confidential manner and will use it only for purposes of determining whether you are an ideal candidate for this procedure.

Are you over the age of 18? (You must be 18 years of age to receive our services).*
No
Yes
Have you had a chemical or laser peel?*
No
Yes
Are you currently using Retin-A or "Alpha Hydroxy" skin care products? (If so, avoid use for 1 month following procedure)*
No
Yes
Are you allergic to topical antibiotic numbing creams or desensitizers?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you*
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes
Do you have any allergies? If yes, list in space provided at the end of the form.*
No
Yes
Are you currently taking medication for high or low blood pressure?*
No
Yes
Will you work out on the day of treatment?*
No
Yes

Botox (date of last treatment)

What is the date of service: *
Do you currently have and/or have had in the past, and/or have you experienced any of the following:
Hemophilia
Do you have problems with healing of wounds?
Diabetes mellitus (diabetes)
Hepatitis A, B, C, D, E, F
HIV +
Eczema
Are you prone to herpes?
Infectious diseases / high fever
Epilepsy
Cardiovascular problems
Do you have a pacemaker?
Are you taking medication for blood thinning (anticoagulants)?
Are you pregnant?
Are you breastfeeding?
Have you received tattoo, micropigmentation or camouflage tattoo in the past 6 months on the areas to be treated?

Please list any skin diseases:

Please list any allergies:

Please list any autoimmune diseases:

Please list any medications taken on a daily basis:
Have you consumed drugs or alcohol in the last 24 hours?*
No
Yes
Did you in the last 14 days undergo surgery, in which you were you exposed to radiation, or any other medical interventions?*
No
Yes
Have you ever been allergic to, or have had an allergic reaction to tattooing (tattoo pigments) or any of the related products used in the delivery of tattooing services?*
No
Yes

Please record the cost of your Camouflage Tattoo service.

SECTION 4: USE OF LIKENESS AND RELEASE (PHOTOS & VIDEO)

By participating as a client, I permit, authorize, and license the technician(s) and the Business and their employees, officers, directors, contractors, and agents of each and all of them ("Authorized Persons"), to display, publicly perform, exhibit, transmit, broadcast, reproduce, record, photograph, digitize, modify, alter, edit, adapt, create derivative works, exploit, sell, rent, license, otherwise use, and permit others to use my image, likeness, and appearance, and all materials created by or on behalf of my participation that incorporates any of the foregoing ("Materials") on a perpetual basis throughout the world and in any medium or format whatsoever now existing or hereafter created for publicity, advertising, and marketing purposes, and for any purpose they deem reasonably appropriate, without further consent from or royalty, payment, or other compensation to me. I agree that all right, title and interest in and to all such Materials is the exclusive property of the Authorized Persons. I understand that the Authorized Persons may keep or use the Materials now and in the future. I understand that although the Authorized Persons will endeavour to use my image, likeness, and appearance in accordance with standards of good judgment, they cannot warrant or guarantee that any further dissemination of my image, likeness, and appearance will be subject to their supervision or control. Accordingly, I release the Authorized Persons from all liability or responsibility that may arise from the acts that I have authorized or consented to in this Section.*
No
Yes

SECTION 5: GENERAL RELEASE AND WAIVER

I recognize and acknowledge that there are certain risks of personal injury or property damage related to my participation as a client, and I voluntarily agree to fully assume all of these risks, regardless of severity, that I may sustain as a result of participating in any and all activities connected with or associated with the application by the technician of brow lamination and/or colouring to my eyebrows using the Brow Lamination technique, including, but not limited to, injuries, damages and losses arising out of negligent supervision, tort, contract, products, or any other theory of recovery. I, for myself and my heirs, assigns, personal representatives, and next of kin, expressly waive and release any and all claims, now known or hereafter known, against the Business, and their employees, officers, directors, contractors, and agents of each and all of them (collectively, "Releasees"), on account of personal injury or property damage arising out of or attributable to my participation as a client, whether arising out of the negligence of any Releasees or otherwise. I covenant not to make or bring any such claim against any Releasee, and forever release and discharge all Releasees from liability under such claims. All matters arising out of or relating to this waiver and release shall be governed by and construed in accordance with the internal laws of Ontario without giving effect to any choice or conflict of law provision or rule (whether of Ontario or any other jurisdiction). Any claim or cause of action arising under this waiver and release may be brought only in the federal and Provincial courts located in Ontario, Canada and I consent to the exclusive jurisdiction of such courts. I understand that this waiver and release is intended to be as broad and inclusive as permitted by law and that if any portion hereof is held invalid, I agree that the balance shall continue in full legal force and effect. I further agree that if this waiver and release is not valid in Ontario, Canada, it shall be construed as a covenant not to sue anytime, anywhere and for any reason. *
I Agree
I HAVE READ THE INFORMATION IN THIS WAIVER THOROUGHLY. I UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT. I HAVE THE CAPACITY TO PROVIDE INFORMED CONSENT AND I AM SIGNING THIS WAIVER AND RELEASE FREELY AND VOLUNTARILY. *
I Agree

COVID-19 Screening Questions

If you have travelled outside of Canada (or have been exposed to someone who a confirmed case of COVID-19) within 14 days of your scheduled appointment you must have subjected yourself to a period of self-isolation and quarantine before you are eligible to receive any services at Ivonne Sanchez Beauty.

Have you travelled outside of Canada within the past 14 days of the scheduled day of treatment?*
No
Yes
If you have travelled outside of Canada (or have been in contact with someone with COVID-19) within the past 14 days have you developed a cough, fever, or experienced difficulty breathing?*
No
Yes
Click to customize question*
No
Yes
For personal services such as those offered at Ivonne Sanchez Beauty the nature of work performed requires close contact with colleagues and customers (i.e. within 2 metres). These interactions, as well as the need to touch work surfaces and equipment could increase the likelihood that we or you could come in contact with the virus. *
I Agree
Client'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.
Emergency Contact

Emergency Contact's 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.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Age

How you found us:
Area(s) To Be Treated / Treatment Procedure (Please Check): *
Arms
Breasts
Aereola
Thigh
Other

If other:

SECTION 3: HEALTH QUESTIONNAIRE

To perform the Camouflage Tattoo procedure in a safe manner, please answer the following health questions truthfully. We will keep all information disclosed in a confidential manner and will use it only for purposes of determining whether you are an ideal candidate for this procedure.

Are you over the age of 18? (You must be 18 years of age to receive our services).*
No
Yes
Have you had a chemical or laser peel?*
No
Yes
Are you currently using Retin-A or "Alpha Hydroxy" skin care products? (If so, avoid use for 1 month following procedure)*
No
Yes
Are you allergic to topical antibiotic numbing creams or desensitizers?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you*
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes
Do you have any allergies? If yes, list in space provided at the end of the form.*
No
Yes
Are you currently taking medication for high or low blood pressure?*
No
Yes
Will you work out on the day of treatment?*
No
Yes

Botox (date of last treatment)

What is the date of service: *
Do you currently have and/or have had in the past, and/or have you experienced any of the following:
Hemophilia
Do you have problems with healing of wounds?
Diabetes mellitus (diabetes)
Hepatitis A, B, C, D, E, F
HIV +
Eczema
Are you prone to herpes?
Infectious diseases / high fever
Epilepsy
Cardiovascular problems
Do you have a pacemaker?
Are you taking medication for blood thinning (anticoagulants)?
Are you pregnant?
Are you breastfeeding?
Have you received tattoo, micropigmentation or camouflage tattoo in the past 6 months on the areas to be treated?

Please list any skin diseases:

Please list any allergies:

Please list any autoimmune diseases:

Please list any medications taken on a daily basis:
Have you consumed drugs or alcohol in the last 24 hours?*
No
Yes
Did you in the last 14 days undergo surgery, in which you were you exposed to radiation, or any other medical interventions?*
No
Yes
Have you ever been allergic to, or have had an allergic reaction to tattooing (tattoo pigments) or any of the related products used in the delivery of tattooing services?*
No
Yes

Please record the cost of your Camouflage Tattoo service.

SECTION 4: USE OF LIKENESS AND RELEASE (PHOTOS & VIDEO)

By participating as a client, I permit, authorize, and license the technician(s) and the Business and their employees, officers, directors, contractors, and agents of each and all of them ("Authorized Persons"), to display, publicly perform, exhibit, transmit, broadcast, reproduce, record, photograph, digitize, modify, alter, edit, adapt, create derivative works, exploit, sell, rent, license, otherwise use, and permit others to use my image, likeness, and appearance, and all materials created by or on behalf of my participation that incorporates any of the foregoing ("Materials") on a perpetual basis throughout the world and in any medium or format whatsoever now existing or hereafter created for publicity, advertising, and marketing purposes, and for any purpose they deem reasonably appropriate, without further consent from or royalty, payment, or other compensation to me. I agree that all right, title and interest in and to all such Materials is the exclusive property of the Authorized Persons. I understand that the Authorized Persons may keep or use the Materials now and in the future. I understand that although the Authorized Persons will endeavour to use my image, likeness, and appearance in accordance with standards of good judgment, they cannot warrant or guarantee that any further dissemination of my image, likeness, and appearance will be subject to their supervision or control. Accordingly, I release the Authorized Persons from all liability or responsibility that may arise from the acts that I have authorized or consented to in this Section.*
No
Yes

SECTION 5: GENERAL RELEASE AND WAIVER

I recognize and acknowledge that there are certain risks of personal injury or property damage related to my participation as a client, and I voluntarily agree to fully assume all of these risks, regardless of severity, that I may sustain as a result of participating in any and all activities connected with or associated with the application by the technician of brow lamination and/or colouring to my eyebrows using the Brow Lamination technique, including, but not limited to, injuries, damages and losses arising out of negligent supervision, tort, contract, products, or any other theory of recovery. I, for myself and my heirs, assigns, personal representatives, and next of kin, expressly waive and release any and all claims, now known or hereafter known, against the Business, and their employees, officers, directors, contractors, and agents of each and all of them (collectively, "Releasees"), on account of personal injury or property damage arising out of or attributable to my participation as a client, whether arising out of the negligence of any Releasees or otherwise. I covenant not to make or bring any such claim against any Releasee, and forever release and discharge all Releasees from liability under such claims. All matters arising out of or relating to this waiver and release shall be governed by and construed in accordance with the internal laws of Ontario without giving effect to any choice or conflict of law provision or rule (whether of Ontario or any other jurisdiction). Any claim or cause of action arising under this waiver and release may be brought only in the federal and Provincial courts located in Ontario, Canada and I consent to the exclusive jurisdiction of such courts. I understand that this waiver and release is intended to be as broad and inclusive as permitted by law and that if any portion hereof is held invalid, I agree that the balance shall continue in full legal force and effect. I further agree that if this waiver and release is not valid in Ontario, Canada, it shall be construed as a covenant not to sue anytime, anywhere and for any reason. *
I Agree
I HAVE READ THE INFORMATION IN THIS WAIVER THOROUGHLY. I UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT. I HAVE THE CAPACITY TO PROVIDE INFORMED CONSENT AND I AM SIGNING THIS WAIVER AND RELEASE FREELY AND VOLUNTARILY. *
I Agree

COVID-19 Screening Questions

If you have travelled outside of Canada (or have been exposed to someone who a confirmed case of COVID-19) within 14 days of your scheduled appointment you must have subjected yourself to a period of self-isolation and quarantine before you are eligible to receive any services at Ivonne Sanchez Beauty.

Have you travelled outside of Canada within the past 14 days of the scheduled day of treatment?*
No
Yes
If you have travelled outside of Canada (or have been in contact with someone with COVID-19) within the past 14 days have you developed a cough, fever, or experienced difficulty breathing?*
No
Yes
Click to customize question*
No
Yes
For personal services such as those offered at Ivonne Sanchez Beauty the nature of work performed requires close contact with colleagues and customers (i.e. within 2 metres). These interactions, as well as the need to touch work surfaces and equipment could increase the likelihood that we or you could come in contact with the virus. *
I Agree
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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver