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First Guest Name
First Name*
Last Name*
Phone*
First Guest Date of Birth*
Date of Birth
First Guest Signature*
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*
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
Please select if any of the following apply to you:
First Waxing Service (ever)
Previous Reaction to Waxing
Sunburned or Recently Tanned Skin
Diabetes
Current Pregnancy
Allergies
Use of Acne Products (ie Retin A, Accutane, etc)
Anything else we should know about
Anything you want us to know?
Help us grow! Tell me, how did you hear about us?
Google Ad
Social Media
Online Search
Referral
Other
If a referral, please state their name so they can get credit!
Please review and agree:
All scheduled appts are subject to our 24-hour cancellation policy. Fees will automatically be charged to your card that is on file. Appointments canceled with less than 24 hours’ notice will incur a 50% charge of the regular service price. No show appts will be charged 50% of the regular service plus an 18% gratuity for your waxer. *
I agree
I have not withheld any information that may be relevant to my treatment and the results thereof. I am aware that there are often inherent risks associated with waxing procedures and that the services I am about to receive could have unfavorable results including but not limited to: allergic reactions, irritation, burning, redness, scarring, soreness, etc. By signing below, I further agree that I will not hold Salt Wax Society, or my esthetician responsible should there be any unfavorable outcome or result. *
I agree
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*
Date of Birth
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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