Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name of minor. *FirstLastChild's Birthday *Name of Parent/Guardian *FirstLastEmergency Contact Number *Email *Date of minor's appointment. *As the parent or legal guardian of the above listed minor, I give permission for my child to have treatment done. *I agreeI give consent for my child to be in the treatment room without me *I agreeMy child will be accompanied by a legal adult that is not the parent. Minor will be accompanied by an adult nanny, babysitter, aunt, uncle, sister, brother or cousin (must be over 18 years old). *YesNoI confirm I have read and understand all information on the applicable forms for treatment(s) requested above, and accept responsibility on my child’s behalf for any disclosures or liability described on those forms. I agree to supervise any home care procedures that are recommended, as per treatment. *I agreeI have read the above information and give permission for my child to receive services from Elite Lashes & Med Spa of all liability for any services rendered. *I agreeService requested today *Eyelash ExtensionLash-lift/ TintingBrow Lamination/ TintingWaxingFacialHeadspa/ Scalp spaType Name for Electronic Signature *Signature * Clear Signature Submit
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