Wax Release Form

_________________________________________________		_______________
Client Name						 			Date of Service

Please initial the following statements on this form.  All information will be held in complete confidence.
Waxing is the procedure of removing unwanted hair by the means of employing warm wax to the skin.
Client          Student
______         ______     I understand I must not use any type of acid exfoliants in the area to be waxed            
                                            such as glycolic, salicylic or AHA products for at least two weeks prior to       
                                            waxing service on any area of my body.   
______          ______    I must not use any type of Retin-A or any other type of exfoliating medications    
                                            for at least 3 months prior to wax.
______          ______    I must be off the drug Accutane for at least one year prior to any waxing service  
                                            on any area of my body.
______          ______    I have not had any type of Laser treatment within the past 30 days.

______          ______    I further understand I must stay out of the sun for at least 24 hours prior and  
                                            after any waxing service on any area of my body.
______          ______    I understand that I am to wear sun protection with an SPF of 20 or greater in 
                                            The area waxed.
______          ______    I have had the opportunity to ask any questions regarding this procedure 
                                            during the consultation with the Licensed Instructor.
______          ______    It is my responsibility to release this information to the providing aesthetician.

I, __________________________ release _____________________, its employees and students from any and all liability, claims, demands, actions and causes of action whatsoever arising out of or related to any damage or injury that may be sustained by me, whether caused by the negligence of  ______________ or otherwise, before, during and after the waxing service.  I am fully aware of the risks involved and hazards connected with waxing, including but not limited to redness, irritations, ingrown hair, small white bumps, bruising and/or sensitivity to the area and understand that cool ice packs are recommended for any type of these symptoms.  I hereby elect to voluntarily receive the waxing service with full knowledge that waxing may be hazardous.  In signing this release, I acknowledge and represent that I have read this foregoing waiver of Liability and Hold Harmless Agreement, understand it and sign it voluntarily as my own free act; no oral representations or written statements, have been made.  I am at least eighteen (18) years of age and fully competent.

Client Signature__________________________________________         Date____________________

Therapist Signature_______________________________________          Date____________________

 

CLIENT INTAKE UPDATE

DATE	
  CLIENT SIGNATURE		
INSTRUCTOR