Waiver & Release
I authorize Envy Eyes and Wax LLC, hereinafter collectively referred to as my “stylist” to perform the semi-permanent eyelash extension procedure/ Eyelash Perm. I understand this procedure requires individual synthetic eyelashes to be glued to my own natural lashes. I understand it is my responsibility to remain still during the application and to keep my eyes closed during the entire process until otherwise advised. I acknowledge that my stylist has explained to me the methods and procedures concerning the application of semi-permanent eyelash extension application, and that there are certain complications, and risks, inherent both in the application process and in wearing semi-permanent lashes. These risks may include, but are limited to, temporary eyelash loss as a result of improper application techniques or through improper post-application care, transient eye redness and irritation, and allergic reaction to the adhesive, under-eye gel patches and other products.
I acknowledge that I have received no guarantees, warranties, promises, and/or commitments regarding the application process or the products used or applied therein or other statements as to the results of this service. I have revealed or disclosed on the Client Registration, Eyelash History, and the Client Consultation & Design Form all conditions and circumstances regarding my health and health history, medications being taken and any past reactions to products used or medications taken. Additional conditions could occur or be discovered during or after the procedure, which could affect my ability to tolerate the procedure.
I, THE UNDERSIGNED, HEREBY FULLY RELEASE, WAIVE, COVENANT NOT TO SUE, AGREE TO HOLD HARMLESS, AND FOREVER DISCHARGE my stylist, Envy Eyes and Wax LLC, their affiliates, agents employees, officers, directors, independent contractors, and any and all partnerships, corporations, or companies associated with them, from any and all liabilities, demands, claims, losses, injuries, or damages, including court costs and attorneys’ fees and expenses, of any nature arising out of or relating to the application of semi-permanent eyelash extension products. EVEN THOUGH CAUSED IN WHOLE OR IN PART BY A PRE-EXISTING DEFECT, THE NEGLIGENCE (WHETHER SOLE, JOINT, OR CONCURRENT), GROSS NEGLIGENCE, STRICT LIABILITY OR OTHER LEGAL FAULT OF MY STYLIST. IT IS MY EXPRESS INTENT THAT THE ABOVE RELEASE INCLUDES THE RELEASE OF MY STYLIST (INCLUDING THE INDIVIDUALS AND ENTITIES LISTED ABOVE) FROM THE CONSEQUENCES OF THEIR OWN NEGLIGENCE. It is also my express intent that this Waiver and Release Form shall bind the members of my family and spouse, if I am alive, and my heirs, assigns and personal representatives, if I am deceased, and shall be governed by the laws of the State of Hawaii.
I further agree that, should I choose to seek the advice of an attorney regarding said release, I will be responsible for any and all costs of legal services that I incur. I agree that this release shall be in contemplation of any possible damages, either known or unknown at the signing of this waiver and release form, and said damages are specifically waived following the signing of this waiver and release form. I further agree that in the event that any dispute that arises out of or relating to the application of semi-permanent eyelash extension products and/or terms of this Waiver & Release between me, or anyone acting on my behalf, my stylist and/or anyone affiliated with my stylist shall be resolved by binding arbitration before the American Arbitration Association I, the undersigned client, certify that I have read and had explained to me and fully understand the above waiver and release form and am electronically signing it voluntarily as my own free act and deed. I certify that I have consulted with a stylist and have read all applicable literature given to me. I have completed the Client Registration, Eyelash History, and the Client Consultation & Design Form to the best of my knowledge. I accept the explanation of potential complications and risks described herein. I certify I am of sound mind and I am fully capable of executing this waiver and release form for myself. No oral representations, statements, or inducements apart from the foregoing agreement that has been reduced to writing have been made.
I, the undersigned client, acknowledge and fully understand that there might be other known risks not reasonable foreseeable at this time. I, undersigned client, acknowledge that I have read and agree to the provisions, terms, and conditions provided in the Envy Eyes and Wax LLC Waiver and Release Form. I agree to assume all risks of injury associate with eyelash extension application, and agree to hold harmless the stylist and/or anyone affiliated with said professional including, but not limited to, Envy Eyes and Wax, LLC.
I, the undersigned client, hereby give Envy Eyes and Wax LLC and its affiliates, 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 Envy Eyes and Wax LLC and its affiliates from any liability in connection to taking or using said images. It is my choice to give consent to receive a waxing/facial service today. I understand that the information given is strictly confidential and will otherwise be used for no other purpose than to assist in customizing my waxing experience. I also understand that failure on my part to disclose information could result in injury and/or illness and I hereby release the practitioner and Envy Eyes and Wax LLC from any claims resulting from such.
I confirm (to the best of my knowledge) that the information I have provided is accurate and complete. I have not withheld any information that may be relevant to my treatment and/or the results thereof. I am aware that there are often inherent risks associated with skin care services including waxing procedures, and that the services I am about to receive could have unfavorable results including, but not limited to: allergic reaction, irritation, burning, redness, scarring, soreness, etc. By signing below, I further agree that I will not hold Envy Eyes and Wax LLC or its affiliates or any of its employees responsible should there be any unfavorable outcome or result.
I, the undersigned client, acknowledge and fully understand that the CANCELLATION POLICY is 8 HOURS PRIOR TO CANCEL YOUR APPIONTMENT TO AVOID A 50% SERVICE CHARGE. IF YOU FAIL TO CALL, CANCEL ONLINE OR DO A NO SHOW YOUR CREDIT CARD WILL BE CHARGED 100% OF YOUR SERVICE(S) BOOKED.
Microblading/Permanent Makeup Waiver and Release
I ________________, am over the age of 18, am not under the influence of drugs or alcohol, am not pregnant or nursing, am not aware of any mental impairment that may affect my ability to make sound judgment in choosing to have this procedure and effectively care for myself after my procedure. I agree that choosing to have this procedure is strictly voluntary and at my will and desire to receive the indicated permanent cosmetic procedure.
I understand the permanent skin pigmentation procedure carries with it known and unknown complications and consequences associated with this type of cosmetic procedure, including but not limited to: infection, scarring, inconsistent color, and spreading, fanning or fading of pigments. Tattoo inks, dyes and pigments haven’t been approved by the Federal Food & Drug Administration and the health consequences of using these products are unknown. I understand the actual color of the pigment may be modified slightly, due to the tone and color of my skin. I fully understand this is a tattoo process and therefore not an exact science, but an art.I am requesting the permanent skin pigmentation procedure(s), and accept the permanence of the procedure as well as the possible complications and consequences of the said procedure(s). X___________
There is a possibility of an allergic reaction to pigments, numbing solutions and ointments. There is the possibility of infection if I do not take care of the area of micropigmentation properly during the healing process. I take full responsibility for the aftercare necessary to have a safe and healthy healing process. I am aware of this and voluntarily chose to have this procedure done knowing this. Medical conditions, such as, but not limited to Immune Deficiencies, etc. can affect the longevity of Permanent Makeup. I also understand that certain medications such as: thyroid, diabetes, blood pressure,
cholesterol medications, chemotherapy, antibiotics, fish oils, etc. may adversely affect my permanent makeup by fading or changing the color of the pigment. I understand that most facial structures are NOT symmetrical; causing one eyebrow to naturally be higher than the other (and accept this may be the case with myself). The technician will do her best to correct this within reason, but this may not be completely correctable. I will notify my technician of any medications I am taking before my procedure and understand that if my permanent makeup is affected by my medications there is no refund and there may be a touchup fee, if a touchup is required. X____________
I understand that if I have any skin treatments, chemical peels, glycolic acid, salicylic acid, acne medication, Retin-A, laser hair removal, plastic surgery, hair dye on the brows, unprotected sun exposure, tanning booths, during and after healing it may result in adverse changes to my permanent cosmetics. It is my responsibility to keep these substances away from my permanent makeup. I acknowledge some of these potential adverse changes may not be correctable. I understand that there are only a certain number of times I can tattoo each area of skin and that it is in my best interest to take care of and extend the life of my permanent makeup the best I can by following the aftercare instructions given to me. X_________
I have received post procedure instructions and I will strictly adhere to such instructions. I understand that my failure to do so may jeopardize my chances for a successful procedure. If I must return to have my procedure redone or touched up because of this, it will be at my expense. If I am on any mood altering prescription (or non-prescription), or I have been drinking alcohol, I will advise my technician. X _____
I understand that the taking of before and after photographs are a condition of such procedure(s). I certify I have read and initialed the above paragraphs, understand and fully consent to this procedure. I accept full responsibility for the decision to have this cosmetic work done. I release Envy Eyes And Wax, the Establishment in which the procedure is being executed, it’s owner(s) and the Technician from any liability if I develop any adverse reaction to this procedure.