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Salon Extensions Waiver

 

Commitment:

I acknowledge that the hair extensions are very sensitive and different from intact human hair.

I have been informed of the daily maintenance procedure. I will follow the daily maintenance

procedure to keep my extensions in the best condition possible. I am fully aware and

responsible that if I brush my hair hard or if the extensions are pulled that it can be ripped

from the roots which can cause permanent damage to my natural hair growth.

All sales are final including but not limited to the sale of the extension hair and the service

cost to apply them.

I will contact my stylist if I have any painful areas or headaches from the extensions.


CONSENT, RELEASE AND WAIVER OF LIABILITY AGREEMENT

I, the undersigned, consent to have hair extensions applied to my natural hair (the “Service”)

by Gervais Salon & Day Spa Inc., Aura by Gervais LLC and employees (collectively herein, the “Service Provider”). The

Service and its associated risks have been explained to me by the Service Provider in terms

that I understand.

I was given the opportunity to ask the Stylist any questions I have regarding the Service and

I have had those questions answered to my satisfaction. Based on the foregoing, I hereby

assume all of the risks associated with the Service, whether known or unknown, including,

but not limited to, the risk of personal injury or property damage.

Cancellation Policy:

We require one week notice to change, reschedule or cancel extension appointments. Out of respect and support for our Service Providers we will automatically charge the card on file. Please give us a call if you have any questions.


 

First Guest Name
First Name*
Last Name*
Phone*
First Guest Age Acknowledgment*
First Guest Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
First Guest Information
What pronouns do you use?
Photo Consent: I grant my Service Provider permission to reproduce, publish, distribute or otherwise use in any reasonable manner my name, photograph,likeness and statements, including, but not limited to, before and after pictures of my hair in connection with the promotion of the Service or the products used in the Service (or other similar services and products) in all media, including without limitation, the internet, news articles, advertisements, or other electronic or printed materials.*
No
Yes
First Guest Signature*
Second Guest Name
First Name*
Last Name*
Guest Date of Birth*
Date of Birth
Second Guest Information
What pronouns do you use?
Photo Consent: I grant my Service Provider permission to reproduce, publish, distribute or otherwise use in any reasonable manner my name, photograph,likeness and statements, including, but not limited to, before and after pictures of my hair in connection with the promotion of the Service or the products used in the Service (or other similar services and products) in all media, including without limitation, the internet, news articles, advertisements, or other electronic or printed materials.*
No
Yes
Third Guest Name
First Name*
Last Name*
Guest Date of Birth*
Date of Birth
Third Guest Information
What pronouns do you use?
Photo Consent: I grant my Service Provider permission to reproduce, publish, distribute or otherwise use in any reasonable manner my name, photograph,likeness and statements, including, but not limited to, before and after pictures of my hair in connection with the promotion of the Service or the products used in the Service (or other similar services and products) in all media, including without limitation, the internet, news articles, advertisements, or other electronic or printed materials.*
No
Yes
Fourth Guest Name
First Name*
Last Name*
Guest Date of Birth*
Date of Birth
Fourth Guest Information
What pronouns do you use?
Photo Consent: I grant my Service Provider permission to reproduce, publish, distribute or otherwise use in any reasonable manner my name, photograph,likeness and statements, including, but not limited to, before and after pictures of my hair in connection with the promotion of the Service or the products used in the Service (or other similar services and products) in all media, including without limitation, the internet, news articles, advertisements, or other electronic or printed materials.*
No
Yes
Fifth Guest Name
First Name*
Last Name*
Guest Date of Birth*
Date of Birth
Fifth Guest Information
What pronouns do you use?
Photo Consent: I grant my Service Provider permission to reproduce, publish, distribute or otherwise use in any reasonable manner my name, photograph,likeness and statements, including, but not limited to, before and after pictures of my hair in connection with the promotion of the Service or the products used in the Service (or other similar services and products) in all media, including without limitation, the internet, news articles, advertisements, or other electronic or printed materials.*
No
Yes
Sixth Guest Name
First Name*
Last Name*
Guest Date of Birth*
Date of Birth
Sixth Guest Information
What pronouns do you use?
Photo Consent: I grant my Service Provider permission to reproduce, publish, distribute or otherwise use in any reasonable manner my name, photograph,likeness and statements, including, but not limited to, before and after pictures of my hair in connection with the promotion of the Service or the products used in the Service (or other similar services and products) in all media, including without limitation, the internet, news articles, advertisements, or other electronic or printed materials.*
No
Yes
Seventh Guest Name
First Name*
Last Name*
Guest Date of Birth*
Date of Birth
Seventh Guest Information
What pronouns do you use?
Photo Consent: I grant my Service Provider permission to reproduce, publish, distribute or otherwise use in any reasonable manner my name, photograph,likeness and statements, including, but not limited to, before and after pictures of my hair in connection with the promotion of the Service or the products used in the Service (or other similar services and products) in all media, including without limitation, the internet, news articles, advertisements, or other electronic or printed materials.*
No
Yes
Eighth Guest Name
First Name*
Last Name*
Guest Date of Birth*
Date of Birth
Eighth Guest Information
What pronouns do you use?
Photo Consent: I grant my Service Provider permission to reproduce, publish, distribute or otherwise use in any reasonable manner my name, photograph,likeness and statements, including, but not limited to, before and after pictures of my hair in connection with the promotion of the Service or the products used in the Service (or other similar services and products) in all media, including without limitation, the internet, news articles, advertisements, or other electronic or printed materials.*
No
Yes
Ninth Guest Name
First Name*
Last Name*
Guest Date of Birth*
Date of Birth
Ninth Guest Information
What pronouns do you use?
Photo Consent: I grant my Service Provider permission to reproduce, publish, distribute or otherwise use in any reasonable manner my name, photograph,likeness and statements, including, but not limited to, before and after pictures of my hair in connection with the promotion of the Service or the products used in the Service (or other similar services and products) in all media, including without limitation, the internet, news articles, advertisements, or other electronic or printed materials.*
No
Yes
Tenth Guest Name
First Name*
Last Name*
Guest Date of Birth*
Date of Birth
Tenth Guest Information
What pronouns do you use?
Photo Consent: I grant my Service Provider permission to reproduce, publish, distribute or otherwise use in any reasonable manner my name, photograph,likeness and statements, including, but not limited to, before and after pictures of my hair in connection with the promotion of the Service or the products used in the Service (or other similar services and products) in all media, including without limitation, the internet, news articles, advertisements, or other electronic or printed materials.*
No
Yes
Parent or Guardian's Email Address
Email*
Check to receive information and discounts by e-mail from Gervais ONLY
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Last Name*
Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
Parent or Guardian's Information
What pronouns do you use?
Photo Consent: I grant my Service Provider permission to reproduce, publish, distribute or otherwise use in any reasonable manner my name, photograph,likeness and statements, including, but not limited to, before and after pictures of my hair in connection with the promotion of the Service or the products used in the Service (or other similar services and products) in all media, including without limitation, the internet, news articles, advertisements, or other electronic or printed materials.*
No
Yes
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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