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Waiver of Liability


No Known Medical Conditions/Informed Consent:
The following conditions may NOT be suitable for eyelash extensions: eye illness or injury, chronic dry eyes, frequent eye irritation, itching, or watery eyes, recent or current eye infection, blepharoplasty in the last 6 months, blepharitis (inflammation of eyelids), allergies to cyanoacrylate glue adhesives (i.e., surgical glue, nail glue, crazy glue), hypersensitivity to formaldehyde (a by-product released in cyanoacrylate glue adhesives), medical conditions that may contribute to hair and eyelash loss: hyperthyroidism or hypothyroidism, alopecia areata, lupus, diabetes, medications that may contribute to hair or eyelash loss: chemotherapeutic agents used in cancer treatment, anticoagulants (blood thinners), and beta-blockers (used to control blood pressure). Please contact Eyemixx Lashes & Beauty prior to your appointment if you have any of the conditions listed above.

I authorize Eyemixx Lashes & Beauty to apply eyelash extensions to my natural eyelashes on June 4, 2025 and future services for eyelash extensions.



By signing below, I agree to the following:

I understand that due to the natural lash cycle and wear/tear, I will need to maintain my lash extensions with fill-in appointments recommended about every 2 to 3 weeks to keep them full.


I understand it is my responsibility to keep my eyes closed throughout the application process as tearing can cause the lashes to bond together rather than one on one.


I understand that this service requires single synthetic eyelashes to be applied to my natural eyelashes.


I understand the service takes about 2-3 hours. I am aware that some risks of this service may be but are not limited to eye redness and irritation.


I understand fumes from the glue adhesive may cause watery eyes or other reactions. I agree to disclose any allergies that I may have to latex, surgical tapes, cyanoacrylate, etc.


I understand that I am required to follow the aftercare instructions to maintain the health of my natural eyelashes and best retention.


I understand contact lenses must be taken out of my eyes prior to the service and must stay out until the service is completed.


I understand the aftercare instructions to maintain eyelash extensions.


I understand that I must see a certified lash artist if I need to remove my eyelash extensions for any reason.


I acknowledge I have no known medical conditions that may impede upon the lash artist's ability to perform the service, cause adverse reactions to the service or products used before, during, and after the service.


I hereby release any and all persons representing this salon from all claims, demands, damages, actions, and cause of action arising out of the performance of the service. I give consent for Eyemixx Lashes & Beauty to take photographs/videos of my face, eyes, and eyelashes before and after the service for any purpose.


I have read and agree that I completely understand the terms above.








COVID-19 Liability Waiver

Eyemixx Lashes & Beauty is taking extra precautions with every client to include a health review and extra sanitation/disinfection procedures in accordance with CDC guidelines due to Covid-19.

Symptoms may appear 2-14 days after exposure to the virus. People with Covid-19 may experience symptoms such as:

Fever or chills


Cough


Difficulty breathing or shortness of breath

Fatigue


Muscle or body aches

Headache

Loss of taste or smell


Sore throat


Congestion or runny nose


Nausea or vomiting

Diarrhea


I agree to the following:

I understand the above symptoms and affirm that I, as well as all household members, do NOT currently have, nor have experienced the symptoms listed above WITHIN THE LAST 14 DAYS.

I affirm that I, as well as all household members, have NOT been diagnosed with, nor been knowingly exposed to someone with Covid-19 WITHIN THE LAST 14 DAYS.

I affirm that I, as well as all household members, have not traveled outside the country, or to any city considered to be a "hot spot" for Covid-19 infections WITHIN THE LAST 14 DAYS.

I waive all liability of Eyemixx Lashes & Beauty if I contract Covid-19 during my service.

I understand Covid-19 virus has a long incubation period, during which carriers of the virus may not show any signs/symptoms and still be highly contagious. It is impossible to fully determine who is positive and who is not, given the current limits of screening in this location and I accept the risks.

I have read and agree that I completely understand the terms above.

Today's Date: June 4, 2025






First Participant's Name
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I certify that I am 18 years of age or older
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Second Participant's Name
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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*
Middle Name
Last Name*
Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
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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