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Procell Microchanneling Waiver

BUNNY’S LIABILITY WAIVER 

ACKNOWLEDGEMENT OF BUNNY’S POLICIES 

ARRIVAL+ LATE POLICY: Please aim to arrive 5-10 minutes before your scheduled appointment time with clean/makeup free eyes and lashes. If you arrive after your scheduled appointment time, it may not be possible to extend the time available for your booked service; if your service is shortened due to your late arrival, you will still be charged the full cost of the service. Please avoid any caffeine prior to your appointment.

CANCELLATION + NO SHOW: A credit card on file is required to book all appointments. As a courtesy, appointment reminders are sent out 48 hours either by text, email or both. If an appointment is cancelled or rescheduled within 24 hours of your appointment, you will be charged 50% of your service as a cancellation fee. If you reschedule or no show your appointment within 4 hours of your scheduled appointment time, you will be charged 100% of your service as a cancellation fee. A one-time allowance of last minute cancellation or reschedule will be permitted for sickness or family emergency. After that, the cancellation and no show policy is in effect.

REFUND POLICY: You are paying for Artist’s time, product, and other expenses used to provide you with a service. No refunds will be given for any reason on services or products. If you are unhappy with a service, you may contact us within 72 hours of your appointment to discuss your concerns. If a correction can be done to address your concerns, it will be done so with a complimentary 30 minute express touch up if it is at the fault of application or product. Any concerns addressed after 72 hours of your last appointment, or if you failed to follow the proper aftercare instructions, will be charged at the discretion of the artist.

PHOTO CONSENT: I give Bunny’s the absolute right and unrestricted permission to take, use, and display photogenic images of me, through any form of media, print, digital, electronic, broadcast, or otherwise, at any location for art, advertising, media release news articles, marketing, publicity, archival, or any other lawful purpose. I waive any right to royalties or other compensation arising from or related to the use of photogenic images of me. I release and agree to hold harmless, Bunny’s and its employees, associates and representatives from any liability in connection to taking or using said images. 

 

RELEASE OF LIABILITY: I hereby consent to the cosmetic procedure at my own risk. If at any time, I am uncomfortable with the procedure, I will inform my service provider and she will use good faith efforts to rectify the problem, including ending the session if I or the service provide feel it is best. If service provider is uncomfortable applying lashes to me, she will discuss her concerns with me and may end the session if necessary. I release, discharge, hold harmless and absolve Bunny’s and all associated parties (“Released Parties”) from any and all actions, suits, demands of any kind and claims of liability of any nature, including claims of negligence, for any damages or injuries, which I, my heirs, executors, administrators and assigns had, now have by reason of any matter connected in any way with the services provided. By signing this, I understand that I am giving up my rights to sue the released parties for any claims, damages or injuries relating to the services provided. I understand that if I am taking any medications, have undergone any procedures or have any allergies, any and all of these factors may cause certain effects upon receiving services provided. I acknowledge that it is many responsibility to to consult my physician to determine ifI should receive services provided from Bunny’s. I acknowledge that Bunny’s has made no guarantee or representation about the services to me. I understand it is my responsibility to follow the directions of my Artist during the services and aftercare provided to me. I voluntarily assume any and all risk of loss, damage or injury that I may sustain arising out of or as a result of the service provided. I confirm that I was given the opportunity to read this release prior to signing and that I was also given the opportunity to receive a copy of its term. If any part of this form shall be deemed invalid or unenforceable then such part shall be deleted and this form shall be enforced to the maximum extent permitted by law.

I clearly understand and accept the following:

1. The goal of these treatments, as in any cosmetic procedure, is improvement – not perfection. I understand my results might not be perfect, and the number of treatments necessary may vary.

2. There may be more treatments necessary than I anticipated.

3. There are no guarantees that anticipated or expected results will be achieved.

4. I understand that compliance with recommended aftercare guidelines are crucial for healing and prevention of scarring or skin textural changes. Micro-Channeling has a low risk of complications.

I understand the following side effects or complications may occur:

1. Discomfort at the treatment site with transient redness and swelling lasting up to 2-3 days may occur. The treated area may feel like it’s sunburnt for a few hours after treatment.

2. Increased or decreased pigmentation is possible and can take 3-6 months or more to resolve.

3. Loss of pigmented lesions such as freckles may give the appearance of loss of pigment.

4. Small areas of scabbing may occur 2-3 days following the treatment.

5. Infection is possible if proper aftercare guidelines are not followed.

CONTRAINDICATIONS While Micro-Channeling treatments are safe and effective for most people, there are some people who will not be good candidates for these types of treatments. Here is a general contraindication list that should be considered by anyone who is thinking of undergoing Micro-Channeling: 1. Pregnancy – if you are pregnant or nursing you are advised to not receive any MicroChanneling treatments. To date there have been no studies conducted on the effects these treatments may have on an unborn or nursing child. 2. Diabetes – patients with uncontrolled or unstable diabetes should not be treated due to possible healing problems. 3. Accutane or any related acne medication – Accutane or any related drug should be discontinued for a minimum of 6 months prior to undergoing Micro-Channeling. 4. Active Herpes Simplex – in the treatment area. Treatment is possible once the outbreak is healed, however, it may be advisable to talk with your doctor and take prescription strength antiviral medication during your treatment series as the Micro-Channeling may possibly “wake up” the virus. 5. Dry Skin – if your skin is overly dry, you will need to start moisturizing and ensure that the condition is under control prior to undergoing any treatment. 6. Any Active Inflammatory Skin Condition – e.g. eczema, psoriasis, infection, rash, acne rosacea or any type of dermatitis at the treatment site as treatment may aggravate the condition.

COVID-19 RELEASE OF LIABILITY AND ASSUMPTION OF RISK
I desire to participate in receiving services ("Activity")  from Bunny's. As lawful consideration for the value that I will gain by participating in the Activity, I agree to all the terms and conditions set forth in this agreement (this "Agreement").
I AM AWARE AND UNDERSTAND THAT THE ACTIVITIES ARE POTENTIALLY DANGEROUS ACTIVITIES AND INVOLVE THE RISK OF SERIOUS ILLNESS, INJURY AND/OR DEATH. I ACKNOWLEDGE THAT I AM AWARE OF THE COVID-19 VIRUS AND ITS ABILITY TO BE TRANSFERRED FROM PERSON-TO-PERSON CONTACT. I AM ALSO AWARE THAT ANY PERSON MAY CARRY THE VIRUS AND BE ASYMPTOMATIC. I UNDERSTAND THAT THE COMPANY CANNOT GUARANTEE THAT I WILL NOT BECOME INFECTED WITH COVID-19, DESPITE THE COMPANY’S BEST EFFORTS TO ABIDE BY STATE AND FEDERAL GUIDELINES SURROUNDING COVID-19. I ACKNOWLEDGE THAT I AM VOLUNTARILY PARTICIPATING IN THE ACTIVITIES WITH KNOWLEDGE OF THE DANGER OF ILLNESS INVOLVED AND HEREBY AGREE TO ACCEPT AND ASSUME ANY AND ALL RISKS OF ILLNESS, INJURY, OR DEATH.
I hereby expressly waive and release any and all claims, now known or hereafter known, against the Company, and its officers, directors, employees, agents, affiliates, successors, and assigns (collectively, “Releasees”), on account of illness, injury, or death arising out of or attributable to my participation in the Activities. I agree not to make or bring any such claim against the Company or any other Releasee, and forever release and discharge the Company and all other Releasees from liability under such claims.
I shall defend, indemnify, and hold harmless the Company and all other Releasees against any and all losses, damages, liabilities, deficiencies, claims, actions, judgments, settlements, interest, awards, penalties, fines, costs, or expenses of whatever kind, including attorney fees, fees and the costs of enforcing any right to indemnification under this Agreement, and the cost of pursuing any insurance providers, arising out or resulting from any claim of a third party related to the Activities.
This Agreement constitutes the sole and entire Agreement between the Company and me with respect to the subject matter of release of liability and assumption of risk contained herein and supersedes all prior and contemporaneous understandings, agreements, representations, and warranties, both written and oral, with respect to such subject matter. If any term or provision of this Agreement is invalid, illegal, or unenforceable in any jurisdiction, such invalidity, illegality, or unenforceability shall not affect any other term or provision of this Agreement or invalidate or render unenforceable such term or provision in any other jurisdiction. This Agreement is binding on and shall inure to the benefit of the Company and me and their respective successors and assigns. All matters arising out of or relating to this Agreement shall be governed by and construed in accordance with the internal laws of the State of California without giving effect to any choice or conflict of law provision or rule. Any claim or cause of action arising under this Agreement may be brought only in the federal and state courts located in Los Angeles, California and I hereby consent to the exclusive jurisdiction of such courts.


    BY SIGNING, I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD ALL OF THE TERMS OF THIS AGREEMENT AND THAT I AM VOLUNTARILY GIVING UP SUBSTANTIAL LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE THE COMPANY.

 

First Participant's Name

First Name*

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First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

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Middle Name

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Second Participant's Date of Birth*
Third Participant's Name

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Third Participant's Date of Birth*
Fourth Participant's Name

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Fourth Participant's Date of Birth*
Fifth Participant's Name

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Fifth Participant's Date of Birth*
Sixth Participant's Name

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Sixth Participant's Date of Birth*
Seventh Participant's Name

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Seventh Participant's Date of Birth*
Eighth Participant's Name

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Eighth Participant's Date of Birth*
Ninth Participant's Name

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Ninth Participant's Date of Birth*
Tenth Participant's Name

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Tenth Participant's Date of Birth*
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:*
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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 or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*
Medical History
Have experienced any of these health conditions in the past or present? Check all that apply.
Autoimmune Disorder
Arthritis
Asthma
Cancer/System Disease
Cold Sores
Depression/Anxiety
Diabetes
Headaches/Migraines
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Lupus

Any known allergies? Please list

Please list any medications or supplements you are currently taking

Have you ever received Botox or fillers? If so, when?
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 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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