Loading...

Eyelash Extensions 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.

“Eyelash Extensions" add synthetic hairs to the base of natural lash hairs, providing the appearance of length and volume. Eyelash extensions may last up to 4 weeks, depending on each individual hair and its stage in the growth cycle, and other lifestyle factors.

“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 EYELASH EXTENSION 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 EYELASH EXTENSION technique, and that the final result cannot be guaranteed as every client is unique.

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 EYELASH EXTENSION 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 EYELASH EXTENSION is that some of the products or tools could make contact with the eyes, or eye area, resulting in temporary redness, swelling or permanent pain, or chronic eye conditions, up to temporary or permanent vision loss.  Although a low risk of infection it is possible to contract pink eye (conjunctivitis), which is transmitted by direct or indirect contact with infectious eye secretions via contaminated hands, equipment, objects, or solutions.  All clients are advised not to touch their eyes without first washing their hands with hot soapy water. Infections may occur due to a contaminated environment, client's own bacteria, contaminated and/or improperly preprocesed equipment, or unclean hands touching the area. 

There is also a risk that the root of the lashes may press or bend against the skin of the eyelid, causing redness, swelling and pain. This is not the same as an allergic reaction or infection, but must be deal with promptly.

4. The minimum or maximum duration of the EYELASH EXTENSIONS from the procedure cannot be determined with certainty and any timelines provided are an approximation.

5. The technician and the business performing the service on me will not liable for any damages caused to me or my EYELASHES in any way caused by any reason, including allergic reaction, reaction to previous procedures such as previous lash extensions, lash lifts, or lash tints, on the lashes, skin sensitivity, and my failure to follow the Eyelash Extension Aftercare Instructions. As part of the aftercare, apply an approved lash extension product developed specifically for EYELASH EXTENSIONS to prolong the results. 

Since December 2018 Ivonne Sanchez Beauty has closely monitored the success rate of its lash extension service.  Our findings show that only 7% of our clients return to have their lashes prematurely fixed or removed. The primary reason for lash recall is due to not following aftercare recommendations.

I agree as follows:

  1. I understand that should I have any concerns about the possiblity of a reaction or allergy that I will first arrange a glue sensitivity test separately.
  2. I understand that should I choose to have hypoallergnic glue applied for the procedure to avoid any allergic response that this is not a cure-all, that eye irritation may still be experienced, though the chances are quite low.
  3. I understand that should I require or choose hypoallergenic glue that I will request hypoallerenic glue from my technician for all future appointments.
  4. I understand that perming and tinting chemicals and preservatives used in the service are irritants and may cause ocular discomfort. Some serums can cause redness, irritation or chronic meibomian gland dysfunction.
  5. I agree that I have not had any ocular surgeries, including blepharoplatsty (eyelid lifts) or LASIK within the last 12 months.
  6. I agree that a history of eye allergies, eye infections, styes, sensitive eyes, watery eyes or chronic dry eye are contraindications for eyelash or eyebrow services and that I must first have a letter of approval from my doctor before proceeding. 
  7. I realize that my body is unique and the technician or any of the technician's associates cannot predict how my skin may react as a result of the procedure.
  8. I understand that in order to maintain a full, consistent lash look that I must:
    a) not expose my new lashes to water, heat, steam or sweat for the first 24 hours.
    b) be cautious and careful not to sleep on one side of my face over the other
    c) not pull on my lashes
    d) use a lash conditioner as prescribed in the lash after care instructions on our website
  9. I understand that lashes need to be re-filled or reapplied at regular intervals to maintain the best look. It is recommended to refill every 2 weeks for the most optimal look, however 3 and 4 week fills may also be possible. It is increasingly rare that lash extensions last beyond 4 weeks to the extent that they can simply be refilled. Beyond 4 weeks less than 20% of the lashes remain and clients are therefore a candidate for a full new set.
  10. I understand that lash extensions naturally shed with my natural lash hair and that each of my natural lash hairs shed on separate lash cycles every 4 weeks. As such, lash extensions are attached only to lash hairs in the mature or final growth stages.
  11. I understand that it is my responsiblity to be prepared for my appointment and to ensure that:
    a) I have removed any eye makeup prior to the appointment
    b) That I have removed my contacts and stored them safely before the scheduled appointment
    c) Had a snack and used the restroom prior to starting the appointment as the duration can be 90 minutes or longer.
  12. I ACKNOWLEDGE THAT NO GUARANTEES HAVE BEEN MADE TO ME CONCERNING THE RESULTS OF THIS PROCEDURE AND THAT IF I AM A NEW LASH CLIENT THAT I MUST WORK TOGETHER WITH MY LASH TECHNICIAN OVER TIME TO FIND THE BEST APPROACH AND METHODS.
  13. I understand that I have 7 days to schedule my lash fix should there be any problems related to the service. Beyond 7 days it may not be possible to resolve any outstanding issues without performing a fill at cost to me.
  14. I understand that tropical destinations where intense heat and exposure to water will damage my lashes and that Ivonne Sanchez Beauty will not be held responsible for any performance issues that arise from bring in such environments.
  15. I accept full responsibility for determining the final look. As a new client to lash extensions it is not always understood what volume or style we are truly comfortable with until we have been through the process a few times.
  16. I understand that if I am receiving these services at a discounted rate e.g. as a model in the beauty training program, that the service times and work product will not be the same as a regular service and that I am willing to work with the business or the trainee to support their learning.
  17. I understand that there are no refunds.

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 may be taken for services over $200 in order to secure your reservation. This will be applied to your scheduled service subject to the cancellation policy.

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, its staff or contractors in any online forum including but not limited to: Google Reviews, Facebook Reviews, Instagram, Facebook, or Twitter. I will instead contact Ivonne Sanchez Beauty or my lash technician 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) Treated / Treatment Procedure (Please Check):
Eyelashes

If other:

SECTION 3: HEALTH QUESTIONNAIRE

To perform the Eyelash Extension 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 sensitive to Latex or Nitrile?*
No
Yes
Are you allergic to any known lash glues or adhesives*
No
Yes
I understand that if I am or may be allergic to lash glue, adhesives or any products used in the delivery of eyelash extensions that is my responsibility alone to ensure that I ask for a glue sensitivity test AND that I must request that my lash technician use hypoallergenic glue.
I Agree
Have you had any previous lash extensions prior to this appointment?*
No
Yes

If "yes" when?:
For the purposes of education or assistance, I consent to the admittance of authorized observers to the procedure(s).*

What is the date of service: *

What is the procedure being performed: *
Do you wear contact lenses?*
No
Yes
I wear glasses either occasionally or for reading or driving*
No
Yes
If "yes" to the above, I will bring my glasses and discuss with the lash technician to work to find a lash length that is comfortable so that I may wear my glasses. *
I agree
I understand that if I don't bring my glasses, but proceed with the service anyway, that my options to correct the lash length later may be limited.
I Agree

Please list any diseases related to your skin or eyes.

Please list any allergies.
Have you ever been allergic to, or have had an allergic reaction to eyelash extensions or adhesive used in eyelash extension services?*
No
Yes

Please record the cost of the 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
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
Option 2
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) Treated / Treatment Procedure (Please Check):
Eyelashes

If other:

SECTION 3: HEALTH QUESTIONNAIRE

To perform the Eyelash Extension 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 sensitive to Latex or Nitrile?*
No
Yes
Are you allergic to any known lash glues or adhesives*
No
Yes
I understand that if I am or may be allergic to lash glue, adhesives or any products used in the delivery of eyelash extensions that is my responsibility alone to ensure that I ask for a glue sensitivity test AND that I must request that my lash technician use hypoallergenic glue.
I Agree
Have you had any previous lash extensions prior to this appointment?*
No
Yes

If "yes" when?:
For the purposes of education or assistance, I consent to the admittance of authorized observers to the procedure(s).*

What is the date of service: *

What is the procedure being performed: *
Do you wear contact lenses?*
No
Yes
I wear glasses either occasionally or for reading or driving*
No
Yes
If "yes" to the above, I will bring my glasses and discuss with the lash technician to work to find a lash length that is comfortable so that I may wear my glasses. *
I agree
I understand that if I don't bring my glasses, but proceed with the service anyway, that my options to correct the lash length later may be limited.
I Agree

Please list any diseases related to your skin or eyes.

Please list any allergies.
Have you ever been allergic to, or have had an allergic reaction to eyelash extensions or adhesive used in eyelash extension services?*
No
Yes

Please record the cost of the 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
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
Option 2
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) Treated / Treatment Procedure (Please Check):
Eyelashes

If other:

SECTION 3: HEALTH QUESTIONNAIRE

To perform the Eyelash Extension 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 sensitive to Latex or Nitrile?*
No
Yes
Are you allergic to any known lash glues or adhesives*
No
Yes
I understand that if I am or may be allergic to lash glue, adhesives or any products used in the delivery of eyelash extensions that is my responsibility alone to ensure that I ask for a glue sensitivity test AND that I must request that my lash technician use hypoallergenic glue.
I Agree
Have you had any previous lash extensions prior to this appointment?*
No
Yes

If "yes" when?:
For the purposes of education or assistance, I consent to the admittance of authorized observers to the procedure(s).*

What is the date of service: *

What is the procedure being performed: *
Do you wear contact lenses?*
No
Yes
I wear glasses either occasionally or for reading or driving*
No
Yes
If "yes" to the above, I will bring my glasses and discuss with the lash technician to work to find a lash length that is comfortable so that I may wear my glasses. *
I agree
I understand that if I don't bring my glasses, but proceed with the service anyway, that my options to correct the lash length later may be limited.
I Agree

Please list any diseases related to your skin or eyes.

Please list any allergies.
Have you ever been allergic to, or have had an allergic reaction to eyelash extensions or adhesive used in eyelash extension services?*
No
Yes

Please record the cost of the 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
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
Option 2
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) Treated / Treatment Procedure (Please Check):
Eyelashes

If other:

SECTION 3: HEALTH QUESTIONNAIRE

To perform the Eyelash Extension 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 sensitive to Latex or Nitrile?*
No
Yes
Are you allergic to any known lash glues or adhesives*
No
Yes
I understand that if I am or may be allergic to lash glue, adhesives or any products used in the delivery of eyelash extensions that is my responsibility alone to ensure that I ask for a glue sensitivity test AND that I must request that my lash technician use hypoallergenic glue.
I Agree
Have you had any previous lash extensions prior to this appointment?*
No
Yes

If "yes" when?:
For the purposes of education or assistance, I consent to the admittance of authorized observers to the procedure(s).*

What is the date of service: *

What is the procedure being performed: *
Do you wear contact lenses?*
No
Yes
I wear glasses either occasionally or for reading or driving*
No
Yes
If "yes" to the above, I will bring my glasses and discuss with the lash technician to work to find a lash length that is comfortable so that I may wear my glasses. *
I agree
I understand that if I don't bring my glasses, but proceed with the service anyway, that my options to correct the lash length later may be limited.
I Agree

Please list any diseases related to your skin or eyes.

Please list any allergies.
Have you ever been allergic to, or have had an allergic reaction to eyelash extensions or adhesive used in eyelash extension services?*
No
Yes

Please record the cost of the 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
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
Option 2
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) Treated / Treatment Procedure (Please Check):
Eyelashes

If other:

SECTION 3: HEALTH QUESTIONNAIRE

To perform the Eyelash Extension 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 sensitive to Latex or Nitrile?*
No
Yes
Are you allergic to any known lash glues or adhesives*
No
Yes
I understand that if I am or may be allergic to lash glue, adhesives or any products used in the delivery of eyelash extensions that is my responsibility alone to ensure that I ask for a glue sensitivity test AND that I must request that my lash technician use hypoallergenic glue.
I Agree
Have you had any previous lash extensions prior to this appointment?*
No
Yes

If "yes" when?:
For the purposes of education or assistance, I consent to the admittance of authorized observers to the procedure(s).*

What is the date of service: *

What is the procedure being performed: *
Do you wear contact lenses?*
No
Yes
I wear glasses either occasionally or for reading or driving*
No
Yes
If "yes" to the above, I will bring my glasses and discuss with the lash technician to work to find a lash length that is comfortable so that I may wear my glasses. *
I agree
I understand that if I don't bring my glasses, but proceed with the service anyway, that my options to correct the lash length later may be limited.
I Agree

Please list any diseases related to your skin or eyes.

Please list any allergies.
Have you ever been allergic to, or have had an allergic reaction to eyelash extensions or adhesive used in eyelash extension services?*
No
Yes

Please record the cost of the 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
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
Option 2
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) Treated / Treatment Procedure (Please Check):
Eyelashes

If other:

SECTION 3: HEALTH QUESTIONNAIRE

To perform the Eyelash Extension 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 sensitive to Latex or Nitrile?*
No
Yes
Are you allergic to any known lash glues or adhesives*
No
Yes
I understand that if I am or may be allergic to lash glue, adhesives or any products used in the delivery of eyelash extensions that is my responsibility alone to ensure that I ask for a glue sensitivity test AND that I must request that my lash technician use hypoallergenic glue.
I Agree
Have you had any previous lash extensions prior to this appointment?*
No
Yes

If "yes" when?:
For the purposes of education or assistance, I consent to the admittance of authorized observers to the procedure(s).*

What is the date of service: *

What is the procedure being performed: *
Do you wear contact lenses?*
No
Yes
I wear glasses either occasionally or for reading or driving*
No
Yes
If "yes" to the above, I will bring my glasses and discuss with the lash technician to work to find a lash length that is comfortable so that I may wear my glasses. *
I agree
I understand that if I don't bring my glasses, but proceed with the service anyway, that my options to correct the lash length later may be limited.
I Agree

Please list any diseases related to your skin or eyes.

Please list any allergies.
Have you ever been allergic to, or have had an allergic reaction to eyelash extensions or adhesive used in eyelash extension services?*
No
Yes

Please record the cost of the 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
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
Option 2
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) Treated / Treatment Procedure (Please Check):
Eyelashes

If other:

SECTION 3: HEALTH QUESTIONNAIRE

To perform the Eyelash Extension 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 sensitive to Latex or Nitrile?*
No
Yes
Are you allergic to any known lash glues or adhesives*
No
Yes
I understand that if I am or may be allergic to lash glue, adhesives or any products used in the delivery of eyelash extensions that is my responsibility alone to ensure that I ask for a glue sensitivity test AND that I must request that my lash technician use hypoallergenic glue.
I Agree
Have you had any previous lash extensions prior to this appointment?*
No
Yes

If "yes" when?:
For the purposes of education or assistance, I consent to the admittance of authorized observers to the procedure(s).*

What is the date of service: *

What is the procedure being performed: *
Do you wear contact lenses?*
No
Yes
I wear glasses either occasionally or for reading or driving*
No
Yes
If "yes" to the above, I will bring my glasses and discuss with the lash technician to work to find a lash length that is comfortable so that I may wear my glasses. *
I agree
I understand that if I don't bring my glasses, but proceed with the service anyway, that my options to correct the lash length later may be limited.
I Agree

Please list any diseases related to your skin or eyes.

Please list any allergies.
Have you ever been allergic to, or have had an allergic reaction to eyelash extensions or adhesive used in eyelash extension services?*
No
Yes

Please record the cost of the 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
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
Option 2
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) Treated / Treatment Procedure (Please Check):
Eyelashes

If other:

SECTION 3: HEALTH QUESTIONNAIRE

To perform the Eyelash Extension 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 sensitive to Latex or Nitrile?*
No
Yes
Are you allergic to any known lash glues or adhesives*
No
Yes
I understand that if I am or may be allergic to lash glue, adhesives or any products used in the delivery of eyelash extensions that is my responsibility alone to ensure that I ask for a glue sensitivity test AND that I must request that my lash technician use hypoallergenic glue.
I Agree
Have you had any previous lash extensions prior to this appointment?*
No
Yes

If "yes" when?:
For the purposes of education or assistance, I consent to the admittance of authorized observers to the procedure(s).*

What is the date of service: *

What is the procedure being performed: *
Do you wear contact lenses?*
No
Yes
I wear glasses either occasionally or for reading or driving*
No
Yes
If "yes" to the above, I will bring my glasses and discuss with the lash technician to work to find a lash length that is comfortable so that I may wear my glasses. *
I agree
I understand that if I don't bring my glasses, but proceed with the service anyway, that my options to correct the lash length later may be limited.
I Agree

Please list any diseases related to your skin or eyes.

Please list any allergies.
Have you ever been allergic to, or have had an allergic reaction to eyelash extensions or adhesive used in eyelash extension services?*
No
Yes

Please record the cost of the 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
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
Option 2
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) Treated / Treatment Procedure (Please Check):
Eyelashes

If other:

SECTION 3: HEALTH QUESTIONNAIRE

To perform the Eyelash Extension 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 sensitive to Latex or Nitrile?*
No
Yes
Are you allergic to any known lash glues or adhesives*
No
Yes
I understand that if I am or may be allergic to lash glue, adhesives or any products used in the delivery of eyelash extensions that is my responsibility alone to ensure that I ask for a glue sensitivity test AND that I must request that my lash technician use hypoallergenic glue.
I Agree
Have you had any previous lash extensions prior to this appointment?*
No
Yes

If "yes" when?:
For the purposes of education or assistance, I consent to the admittance of authorized observers to the procedure(s).*

What is the date of service: *

What is the procedure being performed: *
Do you wear contact lenses?*
No
Yes
I wear glasses either occasionally or for reading or driving*
No
Yes
If "yes" to the above, I will bring my glasses and discuss with the lash technician to work to find a lash length that is comfortable so that I may wear my glasses. *
I agree
I understand that if I don't bring my glasses, but proceed with the service anyway, that my options to correct the lash length later may be limited.
I Agree

Please list any diseases related to your skin or eyes.

Please list any allergies.
Have you ever been allergic to, or have had an allergic reaction to eyelash extensions or adhesive used in eyelash extension services?*
No
Yes

Please record the cost of the 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
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
Option 2
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) Treated / Treatment Procedure (Please Check):
Eyelashes

If other:

SECTION 3: HEALTH QUESTIONNAIRE

To perform the Eyelash Extension 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 sensitive to Latex or Nitrile?*
No
Yes
Are you allergic to any known lash glues or adhesives*
No
Yes
I understand that if I am or may be allergic to lash glue, adhesives or any products used in the delivery of eyelash extensions that is my responsibility alone to ensure that I ask for a glue sensitivity test AND that I must request that my lash technician use hypoallergenic glue.
I Agree
Have you had any previous lash extensions prior to this appointment?*
No
Yes

If "yes" when?:
For the purposes of education or assistance, I consent to the admittance of authorized observers to the procedure(s).*

What is the date of service: *

What is the procedure being performed: *
Do you wear contact lenses?*
No
Yes
I wear glasses either occasionally or for reading or driving*
No
Yes
If "yes" to the above, I will bring my glasses and discuss with the lash technician to work to find a lash length that is comfortable so that I may wear my glasses. *
I agree
I understand that if I don't bring my glasses, but proceed with the service anyway, that my options to correct the lash length later may be limited.
I Agree

Please list any diseases related to your skin or eyes.

Please list any allergies.
Have you ever been allergic to, or have had an allergic reaction to eyelash extensions or adhesive used in eyelash extension services?*
No
Yes

Please record the cost of the 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
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
Option 2
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) Treated / Treatment Procedure (Please Check):
Eyelashes

If other:

SECTION 3: HEALTH QUESTIONNAIRE

To perform the Eyelash Extension 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 sensitive to Latex or Nitrile?*
No
Yes
Are you allergic to any known lash glues or adhesives*
No
Yes
I understand that if I am or may be allergic to lash glue, adhesives or any products used in the delivery of eyelash extensions that is my responsibility alone to ensure that I ask for a glue sensitivity test AND that I must request that my lash technician use hypoallergenic glue.
I Agree
Have you had any previous lash extensions prior to this appointment?*
No
Yes

If "yes" when?:
For the purposes of education or assistance, I consent to the admittance of authorized observers to the procedure(s).*

What is the date of service: *

What is the procedure being performed: *
Do you wear contact lenses?*
No
Yes
I wear glasses either occasionally or for reading or driving*
No
Yes
If "yes" to the above, I will bring my glasses and discuss with the lash technician to work to find a lash length that is comfortable so that I may wear my glasses. *
I agree
I understand that if I don't bring my glasses, but proceed with the service anyway, that my options to correct the lash length later may be limited.
I Agree

Please list any diseases related to your skin or eyes.

Please list any allergies.
Have you ever been allergic to, or have had an allergic reaction to eyelash extensions or adhesive used in eyelash extension services?*
No
Yes

Please record the cost of the 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
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
Option 2
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