CONSENT FOR EYELASH PROCEDURE

I have agreed to have Luxelash Beauty Bar apply and/or remove from my eyelashes. Before my qualified professional can perform this procedure, I understand I must complete this agreement and provide my informed consent by signing and dating where indicated below.

 
  • 1. Waiver of Liability. I understand there are risks associated with having artificial eyelashes applied to and/or removed from my existing eyelashes, and that not with standing the utmost of care in the application or removal of these products, there still exist risks associated with the procedure and product itself, which include, without limitation, eye irritation, eye pain, discomfort, and, in rare cases, blindness when improperly handled. As part of this procedure, I understand that a certain amount of eyelash adhesive material will be used to attach the artificial lashes to my existing natural eyelashes. Even though the Professional may apply or remove my lashes properly, I understand adhesive material may become dislodged during or after the procedure, which may irritate my eyes or require further follow-up care, at my own expense to prevent damage to my eyes. I also understand there is more than one technique for applying synthetic lashes to my eyelashes, and I will not attribute any liability to Professional Beverly Truong of Flick of the Wrist Lash Studio, as a result of this procedure or the use and care of these lashes. I also agree to defend, indemnify and hold harmless Professional and Flick of the Wrist Lash Studio from any and all claims, actions, expenses, damages and liabilities, including reasonable attorneys’ fees which might be asserted against them as a result of my having this procedure performed, or my purchase of these Flick of the Wrist Lash Studio. As used in this agreement, the terms “Professional” and “Flick of the Wrist Lash Studio” include all of their respective officers, directors, agents, employees, successors and assigns.

  • 2. Permission to Use Pictures. I hereby grant to Beverly Truong of Flick of the Wrist Lash Studio the full right to take, publish and reproduce photographs of me, my face, my eyes and/or eyelashes, both before and after this procedure, for any advertising, education, or other purposes whatsoever, including the right to retouch these photographs as deemed necessary by Flick of the Wrist Lash Studio.  I further expressly assign any copyright in these photographs to Flick of the Wrist Lash Studio. I also grant my consent for Flick of the Wrist Lash Studio  to use my image and likeness as contained in these photographs for any advertising or other purposes, along with any comments I may provide.

 

  • 3. Care and Maintenance. I agree to follow the care and maintenance instructions provided by Flick of the Wrist Lash Studio for the use and care of my lashes, and that if any follow-up care is required due to my own mistake or negligence, or failure to follow these instructions, this will be at my own expense and risk. I understand that if I do any of the following, it may result in damage to my lashes or may cause my lashes to fall off prematurely. Knowing this I agree to follow these tips for best results: I will avoid oil based eye products as these will loosen the bond of my lashes. I will avoid getting my lashes wet within the first 24 hours after my application. For the first two days after application, I understand it is best to avoid swimming, saunas or steam rooms. If I experience any itching or irritation, I agree to contact Flick of the Wrist Lash Studio immediately to have the lash extensions removed. I agree to avoid using waterproof mascara and to not use an eyelash curler, perm, or tint my Lashes.  I agree to not pick, pull or rub my lashes.  I understand that I should not attempt to remove my lash extensions on my own or with any product, but that the procedure requires that my lash extensions be professionally removed.

Name *
Name
Date *
Date
If I am under 18 years of age, I have had my parent or legal guardian consent to this agreement. By his or her signature below, he or she ratifies and consents to this procedure under these terms.
Parent/Guardian Name:
Parent/Guardian Name:
Date 1
Date 1
Parent/Guardian Signature: