Child's Consent Form

If you are under 18 years old, please get your parent's assistance in filling out this form. We will ask that the parent fill the form out in the salon with the child to ensure that consent is given.  While the information below is for the child, the parent or legal guardian will need to add his or her signature at the end.

Name *
Name
Date of Birth *
Date of Birth
Address
Address
Phone *
Phone
Have you shaved within 10 days of your appointment date? *
Are you currently using or have you used any of the following in the past 7 days?
Check all that apply.
Do you have tendencides towards any of the following?
Check all that apply
Are you taking Accutane (or similar) or have you in the past year? *
Brand names include: Accutane, Claravis, Sotret, Accutane, Amnesteem, Myorisan
Accutane Warning: *
Using retinoids (accutane or similar) can cause skin to rip off during the waxing process. For your own safety, we cannot wax you until you have been off of Accutane or similar medications for over a year's time.
I have completed this form to the best of my ability. I will consult with my aesthetician regarding any medicine I am currently taking and any skin tendencies that may be problematic. I give permission to my aesthetician to perform the waxing procedure, sugaring, or skin care procedure and will hold her, her staff, and Sugar Me Wax harmless from any liability that may result from this treatment. I have given an accurate account of the questions asked above including all known allergies or prescription drugs or products I am currently ingesting or using topically. I understand my aesthetician will take every precaution to minimize or eliminate negative reactions as much as possible. I have read and understand the post-treatment home care instructions. I am willing to follow recommendations made by my aesthetician for a home care regimen that can minimize or eliminate possible negative reactions. In the event that I may have additional questions or concerns regarding my treatment or suggested home product / post-treatment care, I will consult with the aesthetician immediately. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I certify that I have read, and fully understand the liability waiver and that I have had sufficient opportunity for discussion to have any questions answered. I understand the procedure and accept the risks.