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Keratin Lash Lift Consent Form

Eyelash Lift and Tint Consent Form

I authorize Asia Yomen to perform beauty services on me and I understand that the service is purely elective.

I understand that a patch test is available for all services upon request. All tests must be done at least 24 hours prior to the day of service.

I understand that I must keep my eyes closed and be still during the entire process until my technician states otherwise.

I agree to disclose any allergies I may have but not limited to surgical tapes, carbon,cyanoacerylate, latex,etc.

I understand that all procedures have risks such as but not limited to eye redness, eyelash damage and irritation.

I understand that I am required to follow proper after care instructions given by my technician.

I understand that lash lifting and tinting is a chemical. Therefore, has the risk of natural lash damage depending on the condition of my natural lashes.

I agree that by reading and signing this consent form I hereby release any and all persons representing Asia Yomen from all claims, damages,demands,actions and cause of actions arising of the performance of any service.

I have read and fully understand this entire consent form. I am sound of mind and am fully capable of excecuting this waiver for myself.

I agree to the following no-refund policy. There will be no refunds for this service. If work is determined to be unsatisfactory, the technician must be contacted within 3 days and will then use their discretion to resolve the issue.

The undersigned confirms receiving, reading and reviewing the consent form which forms part of this agreement. I confirm and agree that I wish to engage the services of Asia Yomen/ Kino by Kimie LLC

Today's date: May 16, 2021

First Participant's Name

First Name*

Last Name*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Information

They say a picture is worth a thousand words and I would be thrilled to use yours! Nothing can beat your personal experience in representing what I do on a daily basis in the studio while simultaneously encouraging others on their own skin journey. Photos allow me to update your progress, create a positive impression of my practice and allow others who may be shy or nervous to get excited about their prospects of receiving treatments. If you enjoy what I do and want to assist on improving my small business I kindly ask that you review the following consent form with consideration.

Photo Release Form 

Permission to Use Photograph(s) and videos taken during treatment.

I grant to Kino by Kimie LLC/ Asia Yomen, its representatives, employees, providers and clients the right to take photographs of me and my property in connection with the above-identified subject. I authorize Kino by Kimie LLC/ Asia Yomen its assigns and transferees to copyright, use and publish the same in print and/or electronically. 

I agree that Kino by Kimie LLC/ Asia Yomen and affiliates may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. 

I have read and understand the above.

I consent to photos being taken before and after on social media outlets and to potential clients:*
No
Yes
I prefer that on the photos:
My first name only be used
No name be used

I understand that I can revoke this release any time in writing and that use of any of my photos or other info authorized by this release will immediately cease.

First Participant's Signature*
Second Participant's Name

First Name*

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

They say a picture is worth a thousand words and I would be thrilled to use yours! Nothing can beat your personal experience in representing what I do on a daily basis in the studio while simultaneously encouraging others on their own skin journey. Photos allow me to update your progress, create a positive impression of my practice and allow others who may be shy or nervous to get excited about their prospects of receiving treatments. If you enjoy what I do and want to assist on improving my small business I kindly ask that you review the following consent form with consideration.

Photo Release Form 

Permission to Use Photograph(s) and videos taken during treatment.

I grant to Kino by Kimie LLC/ Asia Yomen, its representatives, employees, providers and clients the right to take photographs of me and my property in connection with the above-identified subject. I authorize Kino by Kimie LLC/ Asia Yomen its assigns and transferees to copyright, use and publish the same in print and/or electronically. 

I agree that Kino by Kimie LLC/ Asia Yomen and affiliates may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. 

I have read and understand the above.

I consent to photos being taken before and after on social media outlets and to potential clients:*
No
Yes
I prefer that on the photos:
My first name only be used
No name be used

I understand that I can revoke this release any time in writing and that use of any of my photos or other info authorized by this release will immediately cease.

Third Participant's Name

First Name*

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

They say a picture is worth a thousand words and I would be thrilled to use yours! Nothing can beat your personal experience in representing what I do on a daily basis in the studio while simultaneously encouraging others on their own skin journey. Photos allow me to update your progress, create a positive impression of my practice and allow others who may be shy or nervous to get excited about their prospects of receiving treatments. If you enjoy what I do and want to assist on improving my small business I kindly ask that you review the following consent form with consideration.

Photo Release Form 

Permission to Use Photograph(s) and videos taken during treatment.

I grant to Kino by Kimie LLC/ Asia Yomen, its representatives, employees, providers and clients the right to take photographs of me and my property in connection with the above-identified subject. I authorize Kino by Kimie LLC/ Asia Yomen its assigns and transferees to copyright, use and publish the same in print and/or electronically. 

I agree that Kino by Kimie LLC/ Asia Yomen and affiliates may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. 

I have read and understand the above.

I consent to photos being taken before and after on social media outlets and to potential clients:*
No
Yes
I prefer that on the photos:
My first name only be used
No name be used

I understand that I can revoke this release any time in writing and that use of any of my photos or other info authorized by this release will immediately cease.

Fourth Participant's Name

First Name*

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

They say a picture is worth a thousand words and I would be thrilled to use yours! Nothing can beat your personal experience in representing what I do on a daily basis in the studio while simultaneously encouraging others on their own skin journey. Photos allow me to update your progress, create a positive impression of my practice and allow others who may be shy or nervous to get excited about their prospects of receiving treatments. If you enjoy what I do and want to assist on improving my small business I kindly ask that you review the following consent form with consideration.

Photo Release Form 

Permission to Use Photograph(s) and videos taken during treatment.

I grant to Kino by Kimie LLC/ Asia Yomen, its representatives, employees, providers and clients the right to take photographs of me and my property in connection with the above-identified subject. I authorize Kino by Kimie LLC/ Asia Yomen its assigns and transferees to copyright, use and publish the same in print and/or electronically. 

I agree that Kino by Kimie LLC/ Asia Yomen and affiliates may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. 

I have read and understand the above.

I consent to photos being taken before and after on social media outlets and to potential clients:*
No
Yes
I prefer that on the photos:
My first name only be used
No name be used

I understand that I can revoke this release any time in writing and that use of any of my photos or other info authorized by this release will immediately cease.

Fifth Participant's Name

First Name*

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

They say a picture is worth a thousand words and I would be thrilled to use yours! Nothing can beat your personal experience in representing what I do on a daily basis in the studio while simultaneously encouraging others on their own skin journey. Photos allow me to update your progress, create a positive impression of my practice and allow others who may be shy or nervous to get excited about their prospects of receiving treatments. If you enjoy what I do and want to assist on improving my small business I kindly ask that you review the following consent form with consideration.

Photo Release Form 

Permission to Use Photograph(s) and videos taken during treatment.

I grant to Kino by Kimie LLC/ Asia Yomen, its representatives, employees, providers and clients the right to take photographs of me and my property in connection with the above-identified subject. I authorize Kino by Kimie LLC/ Asia Yomen its assigns and transferees to copyright, use and publish the same in print and/or electronically. 

I agree that Kino by Kimie LLC/ Asia Yomen and affiliates may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. 

I have read and understand the above.

I consent to photos being taken before and after on social media outlets and to potential clients:*
No
Yes
I prefer that on the photos:
My first name only be used
No name be used

I understand that I can revoke this release any time in writing and that use of any of my photos or other info authorized by this release will immediately cease.

Sixth Participant's Name

First Name*

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

They say a picture is worth a thousand words and I would be thrilled to use yours! Nothing can beat your personal experience in representing what I do on a daily basis in the studio while simultaneously encouraging others on their own skin journey. Photos allow me to update your progress, create a positive impression of my practice and allow others who may be shy or nervous to get excited about their prospects of receiving treatments. If you enjoy what I do and want to assist on improving my small business I kindly ask that you review the following consent form with consideration.

Photo Release Form 

Permission to Use Photograph(s) and videos taken during treatment.

I grant to Kino by Kimie LLC/ Asia Yomen, its representatives, employees, providers and clients the right to take photographs of me and my property in connection with the above-identified subject. I authorize Kino by Kimie LLC/ Asia Yomen its assigns and transferees to copyright, use and publish the same in print and/or electronically. 

I agree that Kino by Kimie LLC/ Asia Yomen and affiliates may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. 

I have read and understand the above.

I consent to photos being taken before and after on social media outlets and to potential clients:*
No
Yes
I prefer that on the photos:
My first name only be used
No name be used

I understand that I can revoke this release any time in writing and that use of any of my photos or other info authorized by this release will immediately cease.

Seventh Participant's Name

First Name*

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

They say a picture is worth a thousand words and I would be thrilled to use yours! Nothing can beat your personal experience in representing what I do on a daily basis in the studio while simultaneously encouraging others on their own skin journey. Photos allow me to update your progress, create a positive impression of my practice and allow others who may be shy or nervous to get excited about their prospects of receiving treatments. If you enjoy what I do and want to assist on improving my small business I kindly ask that you review the following consent form with consideration.

Photo Release Form 

Permission to Use Photograph(s) and videos taken during treatment.

I grant to Kino by Kimie LLC/ Asia Yomen, its representatives, employees, providers and clients the right to take photographs of me and my property in connection with the above-identified subject. I authorize Kino by Kimie LLC/ Asia Yomen its assigns and transferees to copyright, use and publish the same in print and/or electronically. 

I agree that Kino by Kimie LLC/ Asia Yomen and affiliates may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. 

I have read and understand the above.

I consent to photos being taken before and after on social media outlets and to potential clients:*
No
Yes
I prefer that on the photos:
My first name only be used
No name be used

I understand that I can revoke this release any time in writing and that use of any of my photos or other info authorized by this release will immediately cease.

Eighth Participant's Name

First Name*

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

They say a picture is worth a thousand words and I would be thrilled to use yours! Nothing can beat your personal experience in representing what I do on a daily basis in the studio while simultaneously encouraging others on their own skin journey. Photos allow me to update your progress, create a positive impression of my practice and allow others who may be shy or nervous to get excited about their prospects of receiving treatments. If you enjoy what I do and want to assist on improving my small business I kindly ask that you review the following consent form with consideration.

Photo Release Form 

Permission to Use Photograph(s) and videos taken during treatment.

I grant to Kino by Kimie LLC/ Asia Yomen, its representatives, employees, providers and clients the right to take photographs of me and my property in connection with the above-identified subject. I authorize Kino by Kimie LLC/ Asia Yomen its assigns and transferees to copyright, use and publish the same in print and/or electronically. 

I agree that Kino by Kimie LLC/ Asia Yomen and affiliates may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. 

I have read and understand the above.

I consent to photos being taken before and after on social media outlets and to potential clients:*
No
Yes
I prefer that on the photos:
My first name only be used
No name be used

I understand that I can revoke this release any time in writing and that use of any of my photos or other info authorized by this release will immediately cease.

Ninth Participant's Name

First Name*

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

They say a picture is worth a thousand words and I would be thrilled to use yours! Nothing can beat your personal experience in representing what I do on a daily basis in the studio while simultaneously encouraging others on their own skin journey. Photos allow me to update your progress, create a positive impression of my practice and allow others who may be shy or nervous to get excited about their prospects of receiving treatments. If you enjoy what I do and want to assist on improving my small business I kindly ask that you review the following consent form with consideration.

Photo Release Form 

Permission to Use Photograph(s) and videos taken during treatment.

I grant to Kino by Kimie LLC/ Asia Yomen, its representatives, employees, providers and clients the right to take photographs of me and my property in connection with the above-identified subject. I authorize Kino by Kimie LLC/ Asia Yomen its assigns and transferees to copyright, use and publish the same in print and/or electronically. 

I agree that Kino by Kimie LLC/ Asia Yomen and affiliates may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. 

I have read and understand the above.

I consent to photos being taken before and after on social media outlets and to potential clients:*
No
Yes
I prefer that on the photos:
My first name only be used
No name be used

I understand that I can revoke this release any time in writing and that use of any of my photos or other info authorized by this release will immediately cease.

Tenth Participant's Name

First Name*

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

They say a picture is worth a thousand words and I would be thrilled to use yours! Nothing can beat your personal experience in representing what I do on a daily basis in the studio while simultaneously encouraging others on their own skin journey. Photos allow me to update your progress, create a positive impression of my practice and allow others who may be shy or nervous to get excited about their prospects of receiving treatments. If you enjoy what I do and want to assist on improving my small business I kindly ask that you review the following consent form with consideration.

Photo Release Form 

Permission to Use Photograph(s) and videos taken during treatment.

I grant to Kino by Kimie LLC/ Asia Yomen, its representatives, employees, providers and clients the right to take photographs of me and my property in connection with the above-identified subject. I authorize Kino by Kimie LLC/ Asia Yomen its assigns and transferees to copyright, use and publish the same in print and/or electronically. 

I agree that Kino by Kimie LLC/ Asia Yomen and affiliates may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. 

I have read and understand the above.

I consent to photos being taken before and after on social media outlets and to potential clients:*
No
Yes
I prefer that on the photos:
My first name only be used
No name be used

I understand that I can revoke this release any time in writing and that use of any of my photos or other info authorized by this release will immediately cease.

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*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information

They say a picture is worth a thousand words and I would be thrilled to use yours! Nothing can beat your personal experience in representing what I do on a daily basis in the studio while simultaneously encouraging others on their own skin journey. Photos allow me to update your progress, create a positive impression of my practice and allow others who may be shy or nervous to get excited about their prospects of receiving treatments. If you enjoy what I do and want to assist on improving my small business I kindly ask that you review the following consent form with consideration.

Photo Release Form 

Permission to Use Photograph(s) and videos taken during treatment.

I grant to Kino by Kimie LLC/ Asia Yomen, its representatives, employees, providers and clients the right to take photographs of me and my property in connection with the above-identified subject. I authorize Kino by Kimie LLC/ Asia Yomen its assigns and transferees to copyright, use and publish the same in print and/or electronically. 

I agree that Kino by Kimie LLC/ Asia Yomen and affiliates may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. 

I have read and understand the above.

I consent to photos being taken before and after on social media outlets and to potential clients:*
No
Yes
I prefer that on the photos:
My first name only be used
No name be used

I understand that I can revoke this release any time in writing and that use of any of my photos or other info authorized by this release will immediately cease.

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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