Liability Waiver - Cotton Blossom Skin Care/Amanda Cotton, Esthetician
I hereby consent to and authorize (esthetician) Amanda Cotton to perform the following procedure:
I have voluntarily elected to undergo this treatment/procedure after the nature and purpose of this treatment has been explained to me, along with the risks and hazards involved, by Amanda Cotton.
Although it is impossible to list every potential risk and complication, I have been informed of possible benefits, risks, and complications.
I also 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 the expected results at an additional cost.
I have read and understand the post-treatment home care instructions. I understand how important it is to follow all instructions given to me for post-treatment care. In the event that I may have additional questions or concerns regarding my treatment or suggested home product/post-treatment care, I will consult the esthetician immediately.
I have also, to the best of my knowledge, given an accurate account of my medical history, including all known allergies or prescription drugs or products I am currently ingesting or using topically.
I have read and fully understand this agreement and all information detailed above. I understand the procedure and accept the risks. All of my questions have been answered to my satisfaction and I consent to the terms of this agreement.
I do not hold the esthetician, whose signature appears below, responsible for any of my conditions that were present, but not disclosed at the time of this skin care procedure, or that may occur and which may be affected by the treatment performed today.
My questions regarding the treatment have been answered satisfactorily. I understand the treatment and accept any risks. I hereby release (individual) and (facility) from all liabilities associated with the above indicated treatment.
I agree that this consent supersedes any previous verbal or written disclosures. This consent is valid for all of my facial treatments in the future as well.
Waiver, Release and Assumption of Risk:
I understand that as a result of my participation in this session I could suffer an injury and hereby agree that I am doing so at my own risk. In any event, I acknowledge and agree that I assume the risks associated with any and all activities in which I participate. I acknowledge and agree that no warranties or representations have been made to me regarding the results I will achieve from this session. I understand that results are individual and may vary. I do here and forever release and discharge and hereby hold Amanda Cotton/Cotton Blossom Skin Care harmless from any and all claims, demands, rights of action, or causes of action, present or future, arising out of or connected with my participation in this or any session including any injuries resulting therefrom.
THIS WAIVER AND RELEASE OF LIABILITY INCLUDES, WITHOUT LIMITATION, INJURIES WHICH MAY OCCUR AS A RESULT OF 1) EQUIPMENT THAT MAY MALFUNCTION OR BREAK; 2) ANY SLIP, FALL, DROPPING OF EQUIPMENT OR PROPERTY WITHIN PREMISES; AND 3) AILMENTS DURING/POST INSTRUCTION.
I ACKNOWLEDGE THAT I HAVE THOROUGHLY READ THIS WAIVER AND RELEASE AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. BY SIGNING THIS DOCUMENT, I AM WAIVING ANY RIGHT I OR MY SUCCESSORS MIGHT HAVE TO BRING A LEGAL ACTION OR ASSERT A CLAIM AGAINST AMANDA COTTON or COTTON BLOSSOM SKINCARE.
Client Name (printed) _____________________________________________________________________________ Client Name (signature) ______________________________________________ Date________________________ Esthetician ________________________________________________________Date________________________