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Part I

I authorize Natasha McMurtrey to perform hair removal services . The risks of the cosmetic procedure I have chosen have been disclosed to me. I understand that this procedure(s) may cause side effects. I understand I may experience quickly-dissipating, mild discomfort when the wax removes hair from its root and that some cases may result in complications. I understand that taking antibiotics may make skin more sensitive and susceptible to some skin lifting. I understand that waxing may cause inflammation, welts, hives, skin lifting, reddening and/or small breakouts. Breakouts may occur due to bacteria being pulled out with the hair or sensitivity and/or allergy to the wax. I understand that this is usually not severe and may subside within a few days. If at any time I or the wax specialist are uncomfortable with the procedure, I will inform the wax specialist and she will gladly rectify the problem, including ending the session if I or the wax specialist wish. It has been represented to me that no guarantees, warranties, promises, commitments or other statements as to the results of this treatment have been made, and I acknowledge that I have received no particular representations or guarantees, and I am consenting to the procedure at my own risk. I have revealed or disclosed on the form below, all conditions and circumstances regarding my health and health history, medications being taken and any past reactions to products used. Additional conditions could occur or be discovered during or after the wax service, which could affect my ability to tolerate the service. I understand if anything changes in the future it is my responsibility to inform the wax specialist. I understand that I am responsible for informing my wax specialist before EVERY scheduled service if I have used Accutane, Retin-A or any other topical acne medications, Hydroquinone, Protopic/Tacrolimus, Efudex or any other prescribed topical cream, steroids, antibiotics, alpha or beta-hydroxy acids, facial scrubs, chemical peels, and/or tanning beds.


Part II

I understand the continued results of my wax service requires my careful maintenance. I understand that normal lifestyle can resume after the application. However, during the first 24 hours after my wax service, I should avoid: soaking in a hot bath, hot showers, direct sunlight, sunbathing, artificial tanning, saunas, steam baths, swimming, wearing tight or non-breathing clothes to avoid infection, perfumed products on the waxed skin, touching the waxed skin as the empty follicles may get infected by bacteria, oil-based or tanning products, and products with Alpha Hydroxy Acids (AHA) which may irritate waxed skin.

Part III

I release, give up, acquit and discharge Natasha McMurtrey and/or anyone affiliated including any partnership, corporations or company associated with said individual from any claims or damages of any nature. I agree to pay any costs of legal services necessary to further effect or confirm said release. I further 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 any litigation ensues, it shall be placed before the American Arbitration Association for resolution. I agree that in the event a decision is determined in favor of one party over the other, the prevailing party shall be entitled to reasonable attorney fees and costs as set by the arbitrator. I further agree to hold Natasha McMurtrey nameless and harmless from any and all damages. I release Natasha McMurtrey from any responsibility for pre-existing conditions I have not revealed, or any consequential change to those conditions that arises subsequent to the service(s). I understand that I am responsible for any medical treatment I may need to receive as a result of getting this service(s). I accept full responsibility for these and any other complications, which may arise or result during or following the wax service(s), which are to be performed at my request.

Part IV

I certify that I have read and fully understand the above waiver and release form. I certify that I have consulted with Natasha McMurtrey and have had all of my questions answered. 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 & Release form for myself. I acknowledge and fully understand that there might be other unknown risks not reasonably foreseeable at this time.

Part V

Rescheduling or cancellation requires a 24 hour notice to avoid a 50% service charge. If you are not here within 5 minutes of your scheduled appointment time, you will be considered a "no-show". No-shows are charged 100%.

How did you hear about me?
Have you used or had any of the referenced items in the specified time span? These may have potential contraindications to waxing services and have adverse reactions.

Thanks for submitting!

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