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Brow Lamination | Lash Lift | 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.

“(Eye)Brow Lamination or Lash Lift“ is a form of perm that may include tinting (colouring) service for eyebrows or eyelashes.

“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 BROW LAMINATION or LASH LIFT 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 Brow Lamination or Eyelash Lift technique, and that the final result cannot be guaranteed as each skin type 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 Brow Lamination or Lash Lift 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 brow lamination or lash lift is that some of the products or tools could make contact with the eyes, or eye area, resulting in temporary 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), or bacteria related infections from Staphylococcus aureus. 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.

4. The minimum or maximum duration of the lamination/colour from the procedure cannot be determined with certainty.

5. The technician and the business performing the service on me will not liable for any damages caused to me or my eyebrows in any way caused by any reason, including allergic reaction, reaction to previous procedures such as previous henna/tint on the brow hair, tint or lift on the lash hair, skin sensitivity, and my failure to follow the Aftercare Instructions. As part of the aftercare, apply a moisturizing product developed specifically for Brow Lamination or Eyelash Conditioning to prolong the results.

First Client's Name

First Name*

Middle Name

Last Name*

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

COVID-19 (Coronavirus Screening)

If you have travelled outside of Canada (or have been exposed to someone with 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

SECTION 3: HEALTH QUESTIONNAIRE


To perform the Brow Lamination or Lash Lift 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.

Do you currently have and/or have had in the past, and/or have you experienced any of the following:
Hemophilia
Do you have problems with healing of wounds?
Diabetes mellitus (diabetes)
Hepatitis A, B, C, D, E, F
HIV +
Eczema
Are you prone to herpes?
Infectious diseases / high fever
Epilepsy
Cardiovascular problems
Do you have a pacemaker?
Are you taking medication for blood thinning (anticoagulants)?
Are you pregnant?
Have you tinted your eyebrows or eyelashes in the last 6 months using brow henna, henna or tint/dye?

Please list any skin diseases :

Please list any allergies:

Please list any autoimmune diseases:

Please list any related medications taken on a daily basis:

Additional Questions:

Have you consumed drugs or alcohol in the last 24 hours?*
No
Yes
Did you in the last 14 days undergo surgery, in which you were you exposed to radiation, or any other medical interventions?*
No
Yes
Have you ever been allergic to, or have had an allergic reaction to perm solution?*
No
Yes
Have you ever been allergic to, or have had an allergic reaction to Hair Dye?*
No
Yes
Have you applied Retin-A, AHA ("alpha-hydroxy acids"), or exfoliated your brows within the past 72 hours?*
No
Yes

Please record the name and 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 or eyelash lift and/or colouring to my eyebrows or eyelashes using the Brow Lamination or lash lift 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
First Client's Signature*
Second Client's Name

First Name*

Middle Name

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

COVID-19 (Coronavirus Screening)

If you have travelled outside of Canada (or have been exposed to someone with 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

SECTION 3: HEALTH QUESTIONNAIRE


To perform the Brow Lamination or Lash Lift 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.

Do you currently have and/or have had in the past, and/or have you experienced any of the following:
Hemophilia
Do you have problems with healing of wounds?
Diabetes mellitus (diabetes)
Hepatitis A, B, C, D, E, F
HIV +
Eczema
Are you prone to herpes?
Infectious diseases / high fever
Epilepsy
Cardiovascular problems
Do you have a pacemaker?
Are you taking medication for blood thinning (anticoagulants)?
Are you pregnant?
Have you tinted your eyebrows or eyelashes in the last 6 months using brow henna, henna or tint/dye?

Please list any skin diseases :

Please list any allergies:

Please list any autoimmune diseases:

Please list any related medications taken on a daily basis:

Additional Questions:

Have you consumed drugs or alcohol in the last 24 hours?*
No
Yes
Did you in the last 14 days undergo surgery, in which you were you exposed to radiation, or any other medical interventions?*
No
Yes
Have you ever been allergic to, or have had an allergic reaction to perm solution?*
No
Yes
Have you ever been allergic to, or have had an allergic reaction to Hair Dye?*
No
Yes
Have you applied Retin-A, AHA ("alpha-hydroxy acids"), or exfoliated your brows within the past 72 hours?*
No
Yes

Please record the name and 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 or eyelash lift and/or colouring to my eyebrows or eyelashes using the Brow Lamination or lash lift 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
Third Client's Name

First Name*

Middle Name

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

COVID-19 (Coronavirus Screening)

If you have travelled outside of Canada (or have been exposed to someone with 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

SECTION 3: HEALTH QUESTIONNAIRE


To perform the Brow Lamination or Lash Lift 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.

Do you currently have and/or have had in the past, and/or have you experienced any of the following:
Hemophilia
Do you have problems with healing of wounds?
Diabetes mellitus (diabetes)
Hepatitis A, B, C, D, E, F
HIV +
Eczema
Are you prone to herpes?
Infectious diseases / high fever
Epilepsy
Cardiovascular problems
Do you have a pacemaker?
Are you taking medication for blood thinning (anticoagulants)?
Are you pregnant?
Have you tinted your eyebrows or eyelashes in the last 6 months using brow henna, henna or tint/dye?

Please list any skin diseases :

Please list any allergies:

Please list any autoimmune diseases:

Please list any related medications taken on a daily basis:

Additional Questions:

Have you consumed drugs or alcohol in the last 24 hours?*
No
Yes
Did you in the last 14 days undergo surgery, in which you were you exposed to radiation, or any other medical interventions?*
No
Yes
Have you ever been allergic to, or have had an allergic reaction to perm solution?*
No
Yes
Have you ever been allergic to, or have had an allergic reaction to Hair Dye?*
No
Yes
Have you applied Retin-A, AHA ("alpha-hydroxy acids"), or exfoliated your brows within the past 72 hours?*
No
Yes

Please record the name and 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 or eyelash lift and/or colouring to my eyebrows or eyelashes using the Brow Lamination or lash lift 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
Fourth Client's Name

First Name*

Middle Name

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

COVID-19 (Coronavirus Screening)

If you have travelled outside of Canada (or have been exposed to someone with 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

SECTION 3: HEALTH QUESTIONNAIRE


To perform the Brow Lamination or Lash Lift 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.

Do you currently have and/or have had in the past, and/or have you experienced any of the following:
Hemophilia
Do you have problems with healing of wounds?
Diabetes mellitus (diabetes)
Hepatitis A, B, C, D, E, F
HIV +
Eczema
Are you prone to herpes?
Infectious diseases / high fever
Epilepsy
Cardiovascular problems
Do you have a pacemaker?
Are you taking medication for blood thinning (anticoagulants)?
Are you pregnant?
Have you tinted your eyebrows or eyelashes in the last 6 months using brow henna, henna or tint/dye?

Please list any skin diseases :

Please list any allergies:

Please list any autoimmune diseases:

Please list any related medications taken on a daily basis:

Additional Questions:

Have you consumed drugs or alcohol in the last 24 hours?*
No
Yes
Did you in the last 14 days undergo surgery, in which you were you exposed to radiation, or any other medical interventions?*
No
Yes
Have you ever been allergic to, or have had an allergic reaction to perm solution?*
No
Yes
Have you ever been allergic to, or have had an allergic reaction to Hair Dye?*
No
Yes
Have you applied Retin-A, AHA ("alpha-hydroxy acids"), or exfoliated your brows within the past 72 hours?*
No
Yes

Please record the name and 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 or eyelash lift and/or colouring to my eyebrows or eyelashes using the Brow Lamination or lash lift 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
Fifth Client's Name

First Name*

Middle Name

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

COVID-19 (Coronavirus Screening)

If you have travelled outside of Canada (or have been exposed to someone with 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

SECTION 3: HEALTH QUESTIONNAIRE


To perform the Brow Lamination or Lash Lift 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.

Do you currently have and/or have had in the past, and/or have you experienced any of the following:
Hemophilia
Do you have problems with healing of wounds?
Diabetes mellitus (diabetes)
Hepatitis A, B, C, D, E, F
HIV +
Eczema
Are you prone to herpes?
Infectious diseases / high fever
Epilepsy
Cardiovascular problems
Do you have a pacemaker?
Are you taking medication for blood thinning (anticoagulants)?
Are you pregnant?
Have you tinted your eyebrows or eyelashes in the last 6 months using brow henna, henna or tint/dye?

Please list any skin diseases :

Please list any allergies:

Please list any autoimmune diseases:

Please list any related medications taken on a daily basis:

Additional Questions:

Have you consumed drugs or alcohol in the last 24 hours?*
No
Yes
Did you in the last 14 days undergo surgery, in which you were you exposed to radiation, or any other medical interventions?*
No
Yes
Have you ever been allergic to, or have had an allergic reaction to perm solution?*
No
Yes
Have you ever been allergic to, or have had an allergic reaction to Hair Dye?*
No
Yes
Have you applied Retin-A, AHA ("alpha-hydroxy acids"), or exfoliated your brows within the past 72 hours?*
No
Yes

Please record the name and 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 or eyelash lift and/or colouring to my eyebrows or eyelashes using the Brow Lamination or lash lift 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
Sixth Client's Name

First Name*

Middle Name

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

COVID-19 (Coronavirus Screening)

If you have travelled outside of Canada (or have been exposed to someone with 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

SECTION 3: HEALTH QUESTIONNAIRE


To perform the Brow Lamination or Lash Lift 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.

Do you currently have and/or have had in the past, and/or have you experienced any of the following:
Hemophilia
Do you have problems with healing of wounds?
Diabetes mellitus (diabetes)
Hepatitis A, B, C, D, E, F
HIV +
Eczema
Are you prone to herpes?
Infectious diseases / high fever
Epilepsy
Cardiovascular problems
Do you have a pacemaker?
Are you taking medication for blood thinning (anticoagulants)?
Are you pregnant?
Have you tinted your eyebrows or eyelashes in the last 6 months using brow henna, henna or tint/dye?

Please list any skin diseases :

Please list any allergies:

Please list any autoimmune diseases:

Please list any related medications taken on a daily basis:

Additional Questions:

Have you consumed drugs or alcohol in the last 24 hours?*
No
Yes
Did you in the last 14 days undergo surgery, in which you were you exposed to radiation, or any other medical interventions?*
No
Yes
Have you ever been allergic to, or have had an allergic reaction to perm solution?*
No
Yes
Have you ever been allergic to, or have had an allergic reaction to Hair Dye?*
No
Yes
Have you applied Retin-A, AHA ("alpha-hydroxy acids"), or exfoliated your brows within the past 72 hours?*
No
Yes

Please record the name and 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 or eyelash lift and/or colouring to my eyebrows or eyelashes using the Brow Lamination or lash lift 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
Seventh Client's Name

First Name*

Middle Name

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

COVID-19 (Coronavirus Screening)

If you have travelled outside of Canada (or have been exposed to someone with 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

SECTION 3: HEALTH QUESTIONNAIRE


To perform the Brow Lamination or Lash Lift 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.

Do you currently have and/or have had in the past, and/or have you experienced any of the following:
Hemophilia
Do you have problems with healing of wounds?
Diabetes mellitus (diabetes)
Hepatitis A, B, C, D, E, F
HIV +
Eczema
Are you prone to herpes?
Infectious diseases / high fever
Epilepsy
Cardiovascular problems
Do you have a pacemaker?
Are you taking medication for blood thinning (anticoagulants)?
Are you pregnant?
Have you tinted your eyebrows or eyelashes in the last 6 months using brow henna, henna or tint/dye?

Please list any skin diseases :

Please list any allergies:

Please list any autoimmune diseases:

Please list any related medications taken on a daily basis:

Additional Questions:

Have you consumed drugs or alcohol in the last 24 hours?*
No
Yes
Did you in the last 14 days undergo surgery, in which you were you exposed to radiation, or any other medical interventions?*
No
Yes
Have you ever been allergic to, or have had an allergic reaction to perm solution?*
No
Yes
Have you ever been allergic to, or have had an allergic reaction to Hair Dye?*
No
Yes
Have you applied Retin-A, AHA ("alpha-hydroxy acids"), or exfoliated your brows within the past 72 hours?*
No
Yes

Please record the name and 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 or eyelash lift and/or colouring to my eyebrows or eyelashes using the Brow Lamination or lash lift 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
Eighth Client's Name

First Name*

Middle Name

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

COVID-19 (Coronavirus Screening)

If you have travelled outside of Canada (or have been exposed to someone with 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

SECTION 3: HEALTH QUESTIONNAIRE


To perform the Brow Lamination or Lash Lift 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.

Do you currently have and/or have had in the past, and/or have you experienced any of the following:
Hemophilia
Do you have problems with healing of wounds?
Diabetes mellitus (diabetes)
Hepatitis A, B, C, D, E, F
HIV +
Eczema
Are you prone to herpes?
Infectious diseases / high fever
Epilepsy
Cardiovascular problems
Do you have a pacemaker?
Are you taking medication for blood thinning (anticoagulants)?
Are you pregnant?
Have you tinted your eyebrows or eyelashes in the last 6 months using brow henna, henna or tint/dye?

Please list any skin diseases :

Please list any allergies:

Please list any autoimmune diseases:

Please list any related medications taken on a daily basis:

Additional Questions:

Have you consumed drugs or alcohol in the last 24 hours?*
No
Yes
Did you in the last 14 days undergo surgery, in which you were you exposed to radiation, or any other medical interventions?*
No
Yes
Have you ever been allergic to, or have had an allergic reaction to perm solution?*
No
Yes
Have you ever been allergic to, or have had an allergic reaction to Hair Dye?*
No
Yes
Have you applied Retin-A, AHA ("alpha-hydroxy acids"), or exfoliated your brows within the past 72 hours?*
No
Yes

Please record the name and 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 or eyelash lift and/or colouring to my eyebrows or eyelashes using the Brow Lamination or lash lift 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
Ninth Client's Name

First Name*

Middle Name

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

COVID-19 (Coronavirus Screening)

If you have travelled outside of Canada (or have been exposed to someone with 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

SECTION 3: HEALTH QUESTIONNAIRE


To perform the Brow Lamination or Lash Lift 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.

Do you currently have and/or have had in the past, and/or have you experienced any of the following:
Hemophilia
Do you have problems with healing of wounds?
Diabetes mellitus (diabetes)
Hepatitis A, B, C, D, E, F
HIV +
Eczema
Are you prone to herpes?
Infectious diseases / high fever
Epilepsy
Cardiovascular problems
Do you have a pacemaker?
Are you taking medication for blood thinning (anticoagulants)?
Are you pregnant?
Have you tinted your eyebrows or eyelashes in the last 6 months using brow henna, henna or tint/dye?

Please list any skin diseases :

Please list any allergies:

Please list any autoimmune diseases:

Please list any related medications taken on a daily basis:

Additional Questions:

Have you consumed drugs or alcohol in the last 24 hours?*
No
Yes
Did you in the last 14 days undergo surgery, in which you were you exposed to radiation, or any other medical interventions?*
No
Yes
Have you ever been allergic to, or have had an allergic reaction to perm solution?*
No
Yes
Have you ever been allergic to, or have had an allergic reaction to Hair Dye?*
No
Yes
Have you applied Retin-A, AHA ("alpha-hydroxy acids"), or exfoliated your brows within the past 72 hours?*
No
Yes

Please record the name and 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 or eyelash lift and/or colouring to my eyebrows or eyelashes using the Brow Lamination or lash lift 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
Tenth Client's Name

First Name*

Middle Name

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

COVID-19 (Coronavirus Screening)

If you have travelled outside of Canada (or have been exposed to someone with 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

SECTION 3: HEALTH QUESTIONNAIRE


To perform the Brow Lamination or Lash Lift 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.

Do you currently have and/or have had in the past, and/or have you experienced any of the following:
Hemophilia
Do you have problems with healing of wounds?
Diabetes mellitus (diabetes)
Hepatitis A, B, C, D, E, F
HIV +
Eczema
Are you prone to herpes?
Infectious diseases / high fever
Epilepsy
Cardiovascular problems
Do you have a pacemaker?
Are you taking medication for blood thinning (anticoagulants)?
Are you pregnant?
Have you tinted your eyebrows or eyelashes in the last 6 months using brow henna, henna or tint/dye?

Please list any skin diseases :

Please list any allergies:

Please list any autoimmune diseases:

Please list any related medications taken on a daily basis:

Additional Questions:

Have you consumed drugs or alcohol in the last 24 hours?*
No
Yes
Did you in the last 14 days undergo surgery, in which you were you exposed to radiation, or any other medical interventions?*
No
Yes
Have you ever been allergic to, or have had an allergic reaction to perm solution?*
No
Yes
Have you ever been allergic to, or have had an allergic reaction to Hair Dye?*
No
Yes
Have you applied Retin-A, AHA ("alpha-hydroxy acids"), or exfoliated your brows within the past 72 hours?*
No
Yes

Please record the name and 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 or eyelash lift and/or colouring to my eyebrows or eyelashes using the Brow Lamination or lash lift 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
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*

Middle Name

Last Name*

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

COVID-19 (Coronavirus Screening)

If you have travelled outside of Canada (or have been exposed to someone with 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

SECTION 3: HEALTH QUESTIONNAIRE


To perform the Brow Lamination or Lash Lift 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.

Do you currently have and/or have had in the past, and/or have you experienced any of the following:
Hemophilia
Do you have problems with healing of wounds?
Diabetes mellitus (diabetes)
Hepatitis A, B, C, D, E, F
HIV +
Eczema
Are you prone to herpes?
Infectious diseases / high fever
Epilepsy
Cardiovascular problems
Do you have a pacemaker?
Are you taking medication for blood thinning (anticoagulants)?
Are you pregnant?
Have you tinted your eyebrows or eyelashes in the last 6 months using brow henna, henna or tint/dye?

Please list any skin diseases :

Please list any allergies:

Please list any autoimmune diseases:

Please list any related medications taken on a daily basis:

Additional Questions:

Have you consumed drugs or alcohol in the last 24 hours?*
No
Yes
Did you in the last 14 days undergo surgery, in which you were you exposed to radiation, or any other medical interventions?*
No
Yes
Have you ever been allergic to, or have had an allergic reaction to perm solution?*
No
Yes
Have you ever been allergic to, or have had an allergic reaction to Hair Dye?*
No
Yes
Have you applied Retin-A, AHA ("alpha-hydroxy acids"), or exfoliated your brows within the past 72 hours?*
No
Yes

Please record the name and 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 or eyelash lift and/or colouring to my eyebrows or eyelashes using the Brow Lamination or lash lift 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
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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