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Salon Chemical Waiver

Thank you for choosing to receive a chemical service with us. We pride ourselves on our high level of skill and our long lasting relationships with our guests. There are a few things that can make your service results successful. 

Disclaimer:

  • Chemical services can have varying results based on your individual hair.
  • It is extremely important that you make your stylist aware of any and all other processes you have used on your hair.
  • Disclose health/lifestyle information such as allergies, medications, using well water, as well as other health or skin conditions that could be effected.
  • Your clothes may be exposed to the chemicals & products despite our best efforts to protect them, if you would prefer you can dress down into a smock to avoid this risk.
  • There is a risk of your jewelry (earrings & necklaces) being damaged or lost during your service, we recommend you remove them before your service.

Please feel comfortable contacting Gervais at any time after your service if you have any questions or concerns.

LIABILITY WAIVER

In accordance with Oregon State Cosmetology Law:

I have made my stylist aware of all of the processes I have used on my hair in the recent months to assist in their assessment of my hair’s current status and the processes that I need to achieve my desired results. I realize that this is very important information and that any information I withhold regarding my previous processes will increase my chances of damage and the potential for unpredictable chemical reactions. Chemical processes may cause some damage to the integrity of my hair. There are products recommended to improve the health of my hair as well as maintain the results after the service. I am aware that my technician has been trained in the service technique and that they will do their absolute best to create the best results and therefore I will not hold liable Gervais Salon and Day Spa Inc., Aura by Gervais LLC or my stylist if the process has unexpected or undesired results.

 

Cancellation Policy:

We require 24hrs notice to change, reschedule or cancel an appointment. 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*
First Guest Date of Birth*
First Guest Information

What Pronouns do you use?
Photo Consent: I grant Gervais and my stylist 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*
Second Guest Date of Birth*
Second Guest Information

What Pronouns do you use?
Photo Consent: I grant Gervais and my stylist 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*
Third Guest Date of Birth*
Third Guest Information

What Pronouns do you use?
Photo Consent: I grant Gervais and my stylist 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*
Fourth Guest Date of Birth*
Fourth Guest Information

What Pronouns do you use?
Photo Consent: I grant Gervais and my stylist 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*
Fifth Guest Date of Birth*
Fifth Guest Information

What Pronouns do you use?
Photo Consent: I grant Gervais and my stylist 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*
Sixth Guest Date of Birth*
Sixth Guest Information

What Pronouns do you use?
Photo Consent: I grant Gervais and my stylist 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*
Seventh Guest Date of Birth*
Seventh Guest Information

What Pronouns do you use?
Photo Consent: I grant Gervais and my stylist 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*
Eighth Guest Date of Birth*
Eighth Guest Information

What Pronouns do you use?
Photo Consent: I grant Gervais and my stylist 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*
Ninth Guest Date of Birth*
Ninth Guest Information

What Pronouns do you use?
Photo Consent: I grant Gervais and my stylist 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*
Tenth Guest Date of Birth*
Tenth Guest Information

What Pronouns do you use?
Photo Consent: I grant Gervais and my stylist 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 Date of Birth*
Parent or Guardian's Information

What Pronouns do you use?
Photo Consent: I grant Gervais and my stylist 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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