Salon Intake Form

Salon Intake and Release of Liability Form

The following information will be kept confidential and only used to help our stylists plan safe and effective services.



All appointments will be confirmed by text message and e-mail.
24-hour notice is requested for any rescheduling or cancellations.

For liability reasons, and for their safely, children are not allowed in the salon area unless receiving a service. Clients under the age of 17 must have a parent or legal guardian present during any salon or spa service.



You must wait a minimum of seven (7) days before waxing after a light chemical peel or microdermabrasion. Waxing cannot be performed if you have had laser skin resurfacing within the past year.

Waxing cannot be performed if you have had a physician administered peel within the past two (2) years. Sunburned, irritated areas, cold sores, and moles cannot be waxed.

Due to water retention and for your own comfort, you should avoid genital hair removal two days before your cycle to two days after it is completed.

Please note that waxing can have certain side effects such as skin removal, redness, swelling, tenderness, etc.

I, verify that I understand and agree to the following terms and conditions for receiving salon services at .

Hair Service Release

  •   I understand that chemical treatments have different effects on different hair types and colors. I agree to hold the and the stylist harmless in the even of undesired results. I have had the process and possible results adequately explained to me. I have been given the opportunity to make requests and ask any questions I may have. I understand that any further alterations or corrections will be provided at my own expense.
  •   I understand that the chemicals may have unexpected and undesired effects on the metals in my jewelry and on the fabric of my clothing. I verify I have been given the opportunity to remove my jewelry for the duration of my treatment.
  •   I understand that my stylist is a state certified cosmetologist who will try their best to create my desired results. I understand that the best way to assist my stylist is to be clear about my request, and to disclose any and all information about previous hair treatments and chemical services.
  •   I understand that all employees of  are licensed professionals, and that by law they have the right to refuse service on any client at any time, if they feel as though their well-being is compromised.

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Waxing Service Release

  •   I understand and have read and completed this questionnaire truthfully. I agree that this constitutes full disclosure, and that supersedes any previous verbal or written disclosures. I certify that I have read, and fully understand the above paragraphs and that I have asked any questions I have prior to service. I understand that withholding information or providing misinformation may result in contraindications and/or irritation to the skin from waxing treatments received.
  •   I am aware that it is my responsibility to inform the service provider of my current medical or health conditions and to update this history. I have given an accurate account of the questions asked above including all known allergies and/or medications I am currently ingesting or using topically. I am willing to follow recommendations made by my service provider for a home care regimen that can minimize or eliminate possible negative reactions. In the event I may have additional questions or concerns regarding my treatment or suggested home care product or post-treatment care, I will consult the salon immediately.
  •   I give permission to my service provider to perform the waxing procedure we have discussed. I understand that while my service provider will take every precaution to minimize or eliminate negative reactions some may occur and will hold and its staff harmless from any side effect or injury that may result from this treatment. The treatments I receive here are voluntary and I release  and my service provider from liability and assume full responsibility thereof.

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Salon Policies Acknowledgement

  •   I understand that the stylists are on a level system and the service prices listed are a starting price.
  •   I understand that children are not allowed in the salon or spa unless they are receiving a service. I acknowledge this is due to liability and safety issues, and to ensure a relaxing experience for all salon and spa guests.
  •   I have read and understand the ’s cancellation policy. I am aware I will receive a courtesy call after my first missed appointment. After my second appointment I will be reminded of the No Show policy and my account will be noted. After my third No Show I acknowledge I will be placed on a strictly walk in service basis, and will not be guaranteed my appointment.
  •   I have read and understand the ’s late policy. I am aware that for the salon and spa to run on schedule and to create the best possible experience for all guests if I arrive more than ten minutes late to my appointment I will be marked as a ‘No Show’ and part or all of my service may need to be rescheduled.
  •   I consent to photographs being taken of my service for use inside .
  •   I consent to photographs of my service being shared on social media on both the main and on my service provider’s business page.
  •   I understand that all employees of  are licensed professionals, and that by law they have the right to refuse service on any client at any time, if they feel as though their well-being is compromised.

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Who will be participating?

Adult  Adult and Children  Children

Parent / Guardian Information

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By clicking 'I Agree' below, you agree that you have read and agree with the terms of the waiver and that the information you provided is accurate. You furthermore agree that your submission of this form, via the 'I Agree' button, shall constitute the execution of this document in exactly the same manner as if you had signed, by hand, a paper version of this agreement.