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Lash Bash New Client Waiver 

Lash Bash Covid-19 Safety Protocols: Updated Mask Policy 6.11.21

We are so happy, joyful and excited that people are vaxing, waxing and lashing!
To keep our community safe and of course always glamorous unless you can provide proof of vaccination we kindly request that you be masked during the duration of your service.

As always, given the proximity of the service and our adherence to standard esthetician protocols, our lash stylists will wear masks as they provide you with gorgeous lashes. We look forward to seeing you soon!

 

 

First Client Name

First Name*

Last Name*

Phone*
First Client Date of Birth*
First Client Signature*
Second Client Name

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

Email*
A signed copy of this waiver will be sent to the email address you provide.
How did you hear about us?
How did you hear about us? *
Google
Yelp
Instagram
Referral

If referral who were you referred by?
Allergies
Do you have any allergies?*
No
Yes

If yes, what are you allergic to?
Intake & Consent
I acknowledge that I have been advised of the potential harmful or negative side effects (such as the premature shedding of my eyelash) that the lash extension procedure or removal may cause to those who have specific medical or skin conditions. I understand that the adhesives and adhesive remover are a skin, eye and mucus membrane irritant and that in rare cases persons may be allergic or have hypersensitivity to synthetics, like cyanoacrolate which in small amount may be present in the adhesive. I understand that the procedure requires that I lay still for up to 2 hours or longer with my eyes shut. I further state that I have no known medical condition that might be aggrevated by the procedure or any medical condition that would prevent me from complying with or heeding to the professional's or Lash Bash instructions or these warnings.
I hereby grant to Professional and Lash Bash, LLC the full right to take, publish and reproduce photographs of me, my face, my eyes and/or eyelashes, both before and after this procedure, for any advertising, education, or other purposes whatsoever, including the right to retouch these photographs as deemed necessary by Professional or Lash Bash.
I understand there are risks associated with having artificial eyelashes applied to and/or removed from my existing eyelashes, and that notwithstanding the utmost of care in the application or removal of these products, there still exist risks associated with the procedure and product itself, which include, without limitation, eye irritation, eye pain, discomfort when improperly handled. As part of this procedure, I understand that a certain amount of eyelash adhesive material will be used to attach the artifucial lashes to my existing eyelashes. Even though the Professional may apply or remove my lashes properly, I understand adhesive material may become dislodged during or after the procedure, which may irritate my eyes or require further follow-up care, at my own expense to prevent damage to my eyes. I also understand there is more than one technique for applying Lash Bash Lashes® to my eyelashes, and I will not attribute any liability to Professional or Lash Bash LLC as a result of this procedure or the use and care of these lashes. I also agree to defend, indemnify and hold harmless Professional and Lash Bash, LLC from any and all claims, actions, expenses, damages and liabilities, including reasonable attorneys'fees which might be asserted against them as a result of my having this procedure performed, or my purchase of these Lash Bash products. As used in this agreement, the terms "Professional" and"Lash Bash, LLC" include all of their respective officers, directors, agents, employees, successors and assigns.
Waxing Clients: I understand that with treatment certain risks are involved and that any complications or side effects from known or unknown causes could occur. I freely assume these risks. I have not used a scrub, Retin-A, Retinol OTC, take home micro-dermabrasion, glycolic peels, other peels, exfoliated or tanned in the last 72 hours. Some possible side effects of waxing include redness, swelling and pimples, but these are temporary and generally fade within 72 hours.
Covid-19 Safety Policy
In booking your appointment for services, you agree to comply with LASH BASH LLC's COVID-19 Safety Policy and Procedures (https://lashbashsalon.com/covid-19policies/). Specifically, while in the salon, you agree to comply with all health and safety measures implemented by LASH BASH LLC, including but not limited to answering the COVID-19 health questionnaire, having your temperature taken before receiving service, wearing a mask while in the salon, maintaining social distancing protocols and utilizing our contactless check-out technology. LASH BASH LLC will not retain your responses to the COVID-19 health questionnaire. You understand that we reserve the right to refuse service to you for failing to comply with any of these measures. While LASH LASH has taken appropriate health and hygiene precautions, we cannot guarantee that these measures will completely protect you from contracting COVID-19 when receiving LASH BASH services. By signing, you agree that you will not hold Lash Bash LLC liable for any transmission of COVID-19 that could occur while receiving LASH BASH services. You also agree that if you have COVID-19 symptoms within 14 days of your visit to LASH BASH, you will immediately notify LASH BASH that you are symptomatic. *
Please select this checkbox to confirm you understand and agree to adhere to our policy
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 Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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