BOULDER BROWS DISCLOSURE & RELEASE FORM

CONTACT & BILLING INFORMATION

HAIR SPARKLES: YOU MUST BE 12 YEARS OR OLDER. NO CONSENT FORM NECESSARY FOR THIS SERVICE.

First Name *

Last Name *

Age *

Street Address *

City *

State *

Zip Code *

Phone Number (no dashes/spaces) *

Email *

Emergency Contact Name *

Relationship to Client *

Phone Number (no dashes/spaces) *

Email

LATE FEE, LATE CANCELLATION, & NO-SHOW POLICY

In order to schedule with us, we must have a valid credit card on file. This card will be securely stored in your account, and will only be charged in the event of a late-fee, late-cancellation, or no-show. *

I Agree

Credit Card (no dashes/spaces) *

CVC *

Expiration *

Billing Zipcode *

IF THE CLIENT IS A MINOR

IF THE CLIENT IS A MINOR (10 TO 17 YEARS OF AGE)

Clients must be at least 10 years of age to receive any hair removal/waxing services. Parental consent is required for clients between 10 and 17 years of age. If under 18, I guarantee that I am the client’s parent or legal guardian, and I am signing this release on behalf of myself and the client.

Are you under 18 years of age? *

I am a minor receiving services with parental consent.

I am a minor seeking services without parental consent.

WE APOLOGIZE, BUT WE ARE UNABLE TO PERFORM ANY SERVICES ON MINORS WITHOUT PROOF OF PARENTAL CONSENT. PLEASE NOTIFY YOUR TECHNICIAN.

Please upload a photo of your parent's Driver's License: *

Parent/Guardian Signature *

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COVID-19 PROTOCOL

Clients must adhere to the following - When arriving to your appointment, follow the posted instructions:

Please complete your consent form prior to entering the shop.
Clients may be required to wear a face-covering during their service, at their technician's request.

Do not enter our facility, and notify us immediately if you believe that you, or someone you've come into contact with in the last 10 days, have tested positive or believe to be a positive COVID-19 case.

By signing below, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that by entering Boulder Brows I may be exposed to or infected by COVID-19 and that such exposure or infection may result in personal injury, illness, permanent disability, and/or death (herein after “Risks”). I understand that the risk of becoming exposed to or infected by COVID-19, may result from the actions, omissions, or negligence of myself or others, including, but not limited to, Boulder Brows employees and others.

I voluntarily agree to assume all the Risks and accept sole responsibility for any injury to myself, including, but not limited to, illness, personal injury, disability, death, damage, loss, claim, liability, or expense, of any kind, that I may experience or incur in connection with my admission to this facility (“Claims”).

On behalf of myself and my employer, my family members, agents, successors, and assigns, I hereby release, covenant not to sue, discharge, and hold harmless Boulder Brows, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims related to the possibility of COVID-19 infections based on the actions, omissions, or negligence of Boulder Brows, its employees, and others, whether a COVID019 infections occurs before, during or after my admission to your facility.

Client Signature *

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PREFERRED METHODS OF COMMUNICATION

I understand that if I need to get in touch with Boulder Brows for all scheduling or other inquiries, I will reach out via one of the following ways: emailing info@boulderbrows.com, or messaging our automated text reminder system at 833-239-6669. Any other method of communication is not appropriate and will not receive a response. Our in-office phone is 303-395-4831, however we do not have a receptionist and thus are not always available to take calls. Emailing, or messaging our 833 number is preferred for requesting a call back, and for last-minute scheduling/rescheduling requests. *

I understand and will adhere to this policy.

CLIENT ACKNOWLEDGEMENT AND DISCLOSURE

What services will you be receiving today? *

Beauty Service (Non-Tattoo)

Cosmetic Tattoo

Tattoo Removal

I consent to the following beauty services: *

I consent to the following Permanent Makeup/Removal services: *

Artist Preference *

Style Preference *

A copy of your ID/Driver's License is required by law to receive any cosmetic tattoo services. Please upload a photo to store on file. *

SERVICE DESCRIPTION

Lash Tinting gives the eyes more definition for 4-6 weeks. Brow Tinting gives the brow hair a more precise and enhanced look by making the hairs and eyebrow area appear darker and more defined. Combined, these tinting services can help you feel more confident without makeup.

POTENTIAL RISKS

Allergic reaction, breakouts, skin irritation, bleeding, and undesirable results can occur. Although every precaution will be made to ensure your safety and well-being before, during and after your tinting application, please be aware of the possible risks below.

Please read the statements below, checking each box, to indicate that you understand the following completely: *

I understand that tinting lashes or brows has some inherent risk of irritation to the orbital eye area, including the eye itself, and could result in stinging or burning, blurry vision and potentially blindness should the tint enter into the eye.

I understand that if the tinting agent, developer, or mixture of both accidentally comes into contact with my eye, my eye will be flushed with water and medical attention may be required.

I understand that some irritation, itching or burning may occur to the skin which comes into contact with the tinting agent.

I understand that there may be some residual dark staining left on the skin following the tinting process of either my lashes, brows or both. This will fade away within a short time.

I understand that, while every attempt will be made to provide me with my chosen color, everyone’s hair absorbs color differently and my final results may not be the color I initially wanted.

I understand that over the course of several weeks, the tint will gradually lighten and fade. Re-tinting will be required to keep the new color fresh. Most clients need to re-tint every 3-4 weeks.

I recognize that results are not guaranteed and that independent results are dependent upon age, skin condition, and lifestyle and that there is the possibility that I may require further treatments of the treated areas to obtain/maintain the expected results at an additional cost.

I agree to Boulder Brows’ No Refund policy on services rendered, and consent to this service.

SERVICE DESCRIPTION

Eyebrows are your most important feature, providing a frame for your face. Shaping your brows will accent your natural size and shape through brow tinting, careful trimming, tweezing, and other hair removal methods, and/or makeup application to create balance, symmetry and harmony.

POTENTIAL RISKS

Allergic reaction, breakouts, skin irritation, bleeding, and undesirable results. Please note that this treatment is completely different from an eyebrow permanent makeup procedure. We are only able to work with existing hair and cannot create the same changes that are limited exclusively to said permanent makeup procedure.

Please read the statements below, checking each box, to indicate that you understand the following completely: *

I understand that there are risks associated with the Brow Shaping procedure.

I hereby consent to and authorize Boulder Brows to perform this service on my eyebrows. I understand this service may entail brow tinting, hair removal, and/or makeup application to the brow area.

I recognize there are no guaranteed results and that independent results are dependent upon age, skin condition, and lifestyle and that there is the possibility I may require further treatments of the treated areas to obtain/maintain the expected results at an additional cost.

This agreement will remain in effect for this service and all future Brow Shaping sessions conducted by my technician or any other technician conducting business at Boulder Brows. I understand that this agreement is binding and that I have read and fully understand all information above.

I release my technician and Boulder Brows from all liability associated with this service.

I agree to Boulder Brows’ No Refund policy on services rendered, and consent to this service.

SERVICE DESCRIPTION

Brow Lamination is a treatment that creates the look of fuller, fluffier, and better-shaped brows. It will not only tame your brows but also keep them in the desired shape for 4 to 6 weeks by redirecting the direction of the hair growth.