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26 Wilson Street Guelph, ON N1H 4G5
519-994-3289 brows@meghanbarbour.ca
meghan barbour.ca

This contract states that Meghan Barbour (referred to as the technician), will provide a lash lift or lash lift+tint on yourself (referred to as the client). I understand that I must fill out this form in its entirety and sign where required in order to have my services done today.

This service is not suitable for those who are pregnant or breastfeeding. The client understands that as part of this procedure eye irritation, pain, itching, watering and discomfort can occur. Although they are rare, allergic reactions can occur. The client releases Meghan Barbour from liability if any type of allergic reaction or other reaction. If you do have an allergic reaction at anytime during or after your procedure today please let me know. You may need to seek medical attention. Allergic reaction response may include redness, itching, swelling, a rash, blistering, dryness, lashes shedding or any other symptoms associated with an allergy. Please note that some medications such as birth control or hormone therapy may result in thinning or loss of natural lashes.

The client understands that they must keep their eyes closed, lay down and be still throughout the entirety of this procedure which may be up to 60 minutes.

The client understands that the lash lift+tint procedure can not be performed without before and after photos. All photos taken are the property of Meghan Barbour brow+beauty and may be used for visual consultations with future clients, social media, advertising and record keeping. The client also understands that any comments/testimonials may be shared on social media and/or website.

In order to have the best results please keep your lashes dry for the next 24 hours. The client understands if they do not follow aftercare instructions that they may have less than desirable results. There are no guarantees of how long the results of a lash lift+tint will last. On average it can be anywhere from 4-8 weeks.

This agreement remains in effect for this procedure and all future lash lift and/or tint procedures. It is the clients responsibility to inform Meghan of any changes of person information or medical information.

Date: October 27, 2020 

First Participant's Name

First Name*

Last Name*

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

Please answer yes or no for the following questions:

Had lash lift before?*
No
Yes
Had lash tinting before?*
No
Yes
Had a bad experience/reaction from either lash lift or tinting?*
No
Yes
Sensitivities to Pigments*
No
Yes
Skin Sensitivities, conditions or problems including eczema of psoriasis*
No
Yes
Currently experiencing eye infection, irritation or conjunctivitis*
No
Yes
Allergies or Sensitivities to adhesives?*
No
Yes
Contact Lenses?*
No
Yes
Any Medical Concerns?*
No
Yes
Any other diseases or medical conditions*
No
Yes
Any allergies?*
No
Yes

If yes please list

Addition comments/information:

I understand the risks and complications of a lash lift+tint and I release my technician from all liability associated with this procedure. I agree to and understand all information in this waiver. By signing this agreement I understand and agree to the pricing and I am responsible to pay the full amount agreed upon. I confirm that the information I have given is correct. 

First Participant's Signature*
Second Participant's Name

First Name*

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

Please answer yes or no for the following questions:

Had lash lift before?*
No
Yes
Had lash tinting before?*
No
Yes
Had a bad experience/reaction from either lash lift or tinting?*
No
Yes
Sensitivities to Pigments*
No
Yes
Skin Sensitivities, conditions or problems including eczema of psoriasis*
No
Yes
Currently experiencing eye infection, irritation or conjunctivitis*
No
Yes
Allergies or Sensitivities to adhesives?*
No
Yes
Contact Lenses?*
No
Yes
Any Medical Concerns?*
No
Yes
Any other diseases or medical conditions*
No
Yes
Any allergies?*
No
Yes

If yes please list

Addition comments/information:

I understand the risks and complications of a lash lift+tint and I release my technician from all liability associated with this procedure. I agree to and understand all information in this waiver. By signing this agreement I understand and agree to the pricing and I am responsible to pay the full amount agreed upon. I confirm that the information I have given is correct. 

Third Participant's Name

First Name*

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

Please answer yes or no for the following questions:

Had lash lift before?*
No
Yes
Had lash tinting before?*
No
Yes
Had a bad experience/reaction from either lash lift or tinting?*
No
Yes
Sensitivities to Pigments*
No
Yes
Skin Sensitivities, conditions or problems including eczema of psoriasis*
No
Yes
Currently experiencing eye infection, irritation or conjunctivitis*
No
Yes
Allergies or Sensitivities to adhesives?*
No
Yes
Contact Lenses?*
No
Yes
Any Medical Concerns?*
No
Yes
Any other diseases or medical conditions*
No
Yes
Any allergies?*
No
Yes

If yes please list

Addition comments/information:

I understand the risks and complications of a lash lift+tint and I release my technician from all liability associated with this procedure. I agree to and understand all information in this waiver. By signing this agreement I understand and agree to the pricing and I am responsible to pay the full amount agreed upon. I confirm that the information I have given is correct. 

Fourth Participant's Name

First Name*

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

Please answer yes or no for the following questions:

Had lash lift before?*
No
Yes
Had lash tinting before?*
No
Yes
Had a bad experience/reaction from either lash lift or tinting?*
No
Yes
Sensitivities to Pigments*
No
Yes
Skin Sensitivities, conditions or problems including eczema of psoriasis*
No
Yes
Currently experiencing eye infection, irritation or conjunctivitis*
No
Yes
Allergies or Sensitivities to adhesives?*
No
Yes
Contact Lenses?*
No
Yes
Any Medical Concerns?*
No
Yes
Any other diseases or medical conditions*
No
Yes
Any allergies?*
No
Yes

If yes please list

Addition comments/information:

I understand the risks and complications of a lash lift+tint and I release my technician from all liability associated with this procedure. I agree to and understand all information in this waiver. By signing this agreement I understand and agree to the pricing and I am responsible to pay the full amount agreed upon. I confirm that the information I have given is correct. 

Fifth Participant's Name

First Name*

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

Please answer yes or no for the following questions:

Had lash lift before?*
No
Yes
Had lash tinting before?*
No
Yes
Had a bad experience/reaction from either lash lift or tinting?*
No
Yes
Sensitivities to Pigments*
No
Yes
Skin Sensitivities, conditions or problems including eczema of psoriasis*
No
Yes
Currently experiencing eye infection, irritation or conjunctivitis*
No
Yes
Allergies or Sensitivities to adhesives?*
No
Yes
Contact Lenses?*
No
Yes
Any Medical Concerns?*
No
Yes
Any other diseases or medical conditions*
No
Yes
Any allergies?*
No
Yes

If yes please list

Addition comments/information:

I understand the risks and complications of a lash lift+tint and I release my technician from all liability associated with this procedure. I agree to and understand all information in this waiver. By signing this agreement I understand and agree to the pricing and I am responsible to pay the full amount agreed upon. I confirm that the information I have given is correct. 

Sixth Participant's Name

First Name*

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

Please answer yes or no for the following questions:

Had lash lift before?*
No
Yes
Had lash tinting before?*
No
Yes
Had a bad experience/reaction from either lash lift or tinting?*
No
Yes
Sensitivities to Pigments*
No
Yes
Skin Sensitivities, conditions or problems including eczema of psoriasis*
No
Yes
Currently experiencing eye infection, irritation or conjunctivitis*
No
Yes
Allergies or Sensitivities to adhesives?*
No
Yes
Contact Lenses?*
No
Yes
Any Medical Concerns?*
No
Yes
Any other diseases or medical conditions*
No
Yes
Any allergies?*
No
Yes

If yes please list

Addition comments/information:

I understand the risks and complications of a lash lift+tint and I release my technician from all liability associated with this procedure. I agree to and understand all information in this waiver. By signing this agreement I understand and agree to the pricing and I am responsible to pay the full amount agreed upon. I confirm that the information I have given is correct. 

Seventh Participant's Name

First Name*

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

Please answer yes or no for the following questions:

Had lash lift before?*
No
Yes
Had lash tinting before?*
No
Yes
Had a bad experience/reaction from either lash lift or tinting?*
No
Yes
Sensitivities to Pigments*
No
Yes
Skin Sensitivities, conditions or problems including eczema of psoriasis*
No
Yes
Currently experiencing eye infection, irritation or conjunctivitis*
No
Yes
Allergies or Sensitivities to adhesives?*
No
Yes
Contact Lenses?*
No
Yes
Any Medical Concerns?*
No
Yes
Any other diseases or medical conditions*
No
Yes
Any allergies?*
No
Yes

If yes please list

Addition comments/information:

I understand the risks and complications of a lash lift+tint and I release my technician from all liability associated with this procedure. I agree to and understand all information in this waiver. By signing this agreement I understand and agree to the pricing and I am responsible to pay the full amount agreed upon. I confirm that the information I have given is correct. 

Eighth Participant's Name

First Name*

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

Please answer yes or no for the following questions:

Had lash lift before?*
No
Yes
Had lash tinting before?*
No
Yes
Had a bad experience/reaction from either lash lift or tinting?*
No
Yes
Sensitivities to Pigments*
No
Yes
Skin Sensitivities, conditions or problems including eczema of psoriasis*
No
Yes
Currently experiencing eye infection, irritation or conjunctivitis*
No
Yes
Allergies or Sensitivities to adhesives?*
No
Yes
Contact Lenses?*
No
Yes
Any Medical Concerns?*
No
Yes
Any other diseases or medical conditions*
No
Yes
Any allergies?*
No
Yes

If yes please list

Addition comments/information:

I understand the risks and complications of a lash lift+tint and I release my technician from all liability associated with this procedure. I agree to and understand all information in this waiver. By signing this agreement I understand and agree to the pricing and I am responsible to pay the full amount agreed upon. I confirm that the information I have given is correct. 

Ninth Participant's Name

First Name*

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

Please answer yes or no for the following questions:

Had lash lift before?*
No
Yes
Had lash tinting before?*
No
Yes
Had a bad experience/reaction from either lash lift or tinting?*
No
Yes
Sensitivities to Pigments*
No
Yes
Skin Sensitivities, conditions or problems including eczema of psoriasis*
No
Yes
Currently experiencing eye infection, irritation or conjunctivitis*
No
Yes
Allergies or Sensitivities to adhesives?*
No
Yes
Contact Lenses?*
No
Yes
Any Medical Concerns?*
No
Yes
Any other diseases or medical conditions*
No
Yes
Any allergies?*
No
Yes

If yes please list

Addition comments/information:

I understand the risks and complications of a lash lift+tint and I release my technician from all liability associated with this procedure. I agree to and understand all information in this waiver. By signing this agreement I understand and agree to the pricing and I am responsible to pay the full amount agreed upon. I confirm that the information I have given is correct. 

Tenth Participant's Name

First Name*

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

Please answer yes or no for the following questions:

Had lash lift before?*
No
Yes
Had lash tinting before?*
No
Yes
Had a bad experience/reaction from either lash lift or tinting?*
No
Yes
Sensitivities to Pigments*
No
Yes
Skin Sensitivities, conditions or problems including eczema of psoriasis*
No
Yes
Currently experiencing eye infection, irritation or conjunctivitis*
No
Yes
Allergies or Sensitivities to adhesives?*
No
Yes
Contact Lenses?*
No
Yes
Any Medical Concerns?*
No
Yes
Any other diseases or medical conditions*
No
Yes
Any allergies?*
No
Yes

If yes please list

Addition comments/information:

I understand the risks and complications of a lash lift+tint and I release my technician from all liability associated with this procedure. I agree to and understand all information in this waiver. By signing this agreement I understand and agree to the pricing and I am responsible to pay the full amount agreed upon. I confirm that the information I have given is correct. 

Participant'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.
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*
Parent or Guardian's Information

Please answer yes or no for the following questions:

Had lash lift before?*
No
Yes
Had lash tinting before?*
No
Yes
Had a bad experience/reaction from either lash lift or tinting?*
No
Yes
Sensitivities to Pigments*
No
Yes
Skin Sensitivities, conditions or problems including eczema of psoriasis*
No
Yes
Currently experiencing eye infection, irritation or conjunctivitis*
No
Yes
Allergies or Sensitivities to adhesives?*
No
Yes
Contact Lenses?*
No
Yes
Any Medical Concerns?*
No
Yes
Any other diseases or medical conditions*
No
Yes
Any allergies?*
No
Yes

If yes please list

Addition comments/information:

I understand the risks and complications of a lash lift+tint and I release my technician from all liability associated with this procedure. I agree to and understand all information in this waiver. By signing this agreement I understand and agree to the pricing and I am responsible to pay the full amount agreed upon. I confirm that the information I have given is correct. 

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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