Consent form

Complete this on your phone or iPad. Charlotte keeps a copy for studio records.

All fields marked * are required. Draw your signature on screen.

Personal details

Full name *

Enter your full name.

Date of birth *

Enter your date of birth.

Mobile number *

Enter a mobile number.

Address *

Enter your address.

Today’s date *

Enter today’s date.

Emergency contact name *

Enter an emergency contact name.

Emergency contact number *

Enter an emergency contact number.

Service type

Lashes Piercing Both

Please choose a service type.

Medical

Do you suffer from any of the following? Tick all that apply, or “none of the above”.

Select at least one condition, or “none of the above” (not both). If Other, add details.

Acknowledgements

I acknowledge that I am…

Not under the influence of drugs or alcohol Not pregnant Over the age of 18 Aware that lashes / piercings can become infected or irritated if proper aftercare isn’t followed Consenting to the treatment and agree to release and forever discharge Tiny Lashes & Co and its artists from any claims, damages or legal actions arising from or connected in any way to my treatment or the procedures and conduct used

Please tick every acknowledgement.

Signature

Printed name *

Enter your printed name as the signer.

Sign below with finger or mouse *