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Eyelash Extensions Agreement and Consent Form

I understand that this procedure requires single synthetic eyelashes to be glued to my own natural eyelashes.

I understand that it is my responsibility to keep my eyes closed and be still during the entire procedure, until my eyelash technician addresses me to open my eyes. 

I understand that some risks of this procedure may be but not limited to eye redness and irritation. The fumes from the adhesive may cause my eyes to tear up if i open my eyes. 

I agree to disclose any allergies that I may have to latex, surgical tapes, cyanoacrylate, Vaseline, etc. 

I understand that I am required to follow the eyelash extension care sheet (Online) in order to maintain the life of these extensions. 

I agree that by signing this consent form, I release Brow house beauty Lash tech from any claims and damages of any nature. 

I agree that I read and fully understand this entire consent form. 

I am of sound mind and fully capable of executing this waiver myself. 

I have read and completed the Eyelash Extensions Intake & Consent form in its entirety, and have answered everything to the best of my ability. I have been informed of potentially harmful or negative side affects that may be caused by the application and/or removal of the Eyelash Extensions. 

I understand that appointments may run over or under resulting in my original appointment time being pushed back. 

I understand that less than 40% of lashes will not be considered a fill and may RESULT IN RESCHEDULING.

I confirm and agree that I wish to engage the services of BROW HOUSE BEAUTY to apply lash extensions.

Today's Date: October 27, 2020

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Information
I give Brow House Beauty Permission to show my before and after photos of eyelashes to other potential clients*
No
Yes
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information
I give Brow House Beauty Permission to show my before and after photos of eyelashes to other potential clients*
No
Yes
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information
I give Brow House Beauty Permission to show my before and after photos of eyelashes to other potential clients*
No
Yes
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information
I give Brow House Beauty Permission to show my before and after photos of eyelashes to other potential clients*
No
Yes
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information
I give Brow House Beauty Permission to show my before and after photos of eyelashes to other potential clients*
No
Yes
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information
I give Brow House Beauty Permission to show my before and after photos of eyelashes to other potential clients*
No
Yes
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information
I give Brow House Beauty Permission to show my before and after photos of eyelashes to other potential clients*
No
Yes
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information
I give Brow House Beauty Permission to show my before and after photos of eyelashes to other potential clients*
No
Yes
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information
I give Brow House Beauty Permission to show my before and after photos of eyelashes to other potential clients*
No
Yes
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information
I give Brow House Beauty Permission to show my before and after photos of eyelashes to other potential clients*
No
Yes
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Referral

Referred by
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information
I give Brow House Beauty Permission to show my before and after photos of eyelashes to other potential clients*
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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