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Full Service Menu
Permanent Makeup (PMU)
Careers
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WHAT ARE YOU LOOKING FOR TODAY?
Search
Home
Services
Full Service Menu
Permanent Makeup (PMU)
Careers
Contacts
WHAT ARE YOU LOOKING FOR TODAY?
Search
Home
Services
Full Service Menu
Permanent Makeup (PMU)
Careers
Contacts
WHAT ARE YOU LOOKING FOR TODAY?
Search
Home
Services
Full Service Menu
Permanent Makeup (PMU)
Careers
Contacts
Eyelash Model Consent
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Eyelash Model Consent
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Date
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Name
*
First
Last
Phone
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Email
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Email
Confirm Email
We request your ID in order to verify your identity, and to ensure that all the information you provide on this form is true and accurate.
*
Click or drag a file to this area to upload.
Please take a photo of your driver license (Front side)
Section 1
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I have agreed to have eyelash extensions applied to my natural eyelashes by MODEL WANTED HOST AND ITS STUDENTS. Before my eyelash professional can perform this procedure, I understand I must complete this agreement and provide my informed consent by signing and dating where indicated below.
Initial Section 1
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Clear Signature
Section 2
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I understand that this procedure requires single synthetic eyelashes to be glued to my own natural eyelashes.
Initial Section 2
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Clear Signature
Section 3
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I understand that it is my responsibility to keep my eyes closed and be still during the entire procedure, until my eyelash technician addresses me to open my eyes.
Initial Section 3
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Clear Signature
Section 4
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I understand that some risks of this procedure may be but not limited to eye redness and irritation. The fumes from the adhesive may cause my eyes to tear up if I open my eyes.
Initial Section 4
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Clear Signature
Section 5
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I agree to disclose any allergies that I may have to latex, surgical tapes, cyanoacrylate, Vaseline, etc.
Initial Section 5
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Clear Signature
Section 6
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I agree that by reading and signing this consent form, I release ELITE LASHES LLC/MODEL WANTED HOST ITS EMPLOYEES AND STUDENTS from any claims or damages of any nature.
Initial Section 6
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Clear Signature
Section 7
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I agree that I read and fully understand this entire consent form
Initial Section 7
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Clear Signature
Section 8
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I am of sound mind and fully capable of executing this waiver for myself.
Initial Section 8
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Clear Signature
Waiver of Liability 1
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I understand there are risk associated with having artificial eyelash extensions applied to and/or removed from my natural eyelashes, and that notwithstanding the utmost of care in the application or removal of these products, there still exists risks associated with the procedure and products itself, which include, without limitation, eye irritation, eye irritation, eye pain, discomfort, and in rare case blindness when improperly handled. As part of this procedure, I understand that a certain amount of eyelash adhesive material will be used to attach artificial eyelashes to my natural eyelashes. Even though the eyelash extension professional may apply or remove the artificial eyelash properly. I understand adhesive material may become dislodged during or after the procedure, which may irritate eye or require follow up care, at my own expense to prevent damage to my eyes. I also agree to defend, indemnify and hold harmless ELITE LASHES LLC, MODEL WANTED HOST, ITS EMPLOYEES & STUDENTS from any and all claims, actions, expenses, damages and liabilities, including reasonable attorneys’ fee which might be asserted against them as a result of my having this procedure performed.
Waiver of Liability 2
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I covenant not to make or bring any such claim against any Release and forever release and discharge all Releases from liability under such claims. All matters arising out of or relating to this waiver and release shall be governed by and construed in accordance with the internal laws of the United States without giving effect to any choice or conflict of law provision or rule (whether of the United States or any other jurisdiction). Any claim or cause of action arising under this waiver and release may be brought only in the federal and local courts located in the United States and I consent to the exclusive jurisdiction of such courts. I understand that this waiver and release is intended to be as broad and inclusive as permitted by law and that if any portion hereof is held invalid, I agree that the balance shall continue in full legal force and effect. I further agree that if this waiver and release is not valid in the United States, it shall be construed as a covenant not to sue anytime, anywhere and for any reason. I am signing below stating that i fully comprehend everything stated to me in the WAIVER OF LIABILITY
Initial Waiver of Liability 1 & 2
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Clear Signature
No know medical conditions/ informed consent
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I have read and completed ELITE LASHES LLC/MODEL WANTED HOST client intake form in it’s entirely and in truth. I acknowledge that I have been advised of the potentially harmful or negative side effects that the eyelash extension procedure or removal may cause to those who have specific medical or skin conditions. I understand that the adhesives and adhesive remover are a skin, eye and mucus membrane irritant and that in rare cases persons may be allergic or have hypersensitivity to synthetics, cyanoacrylate or formaldehyde which in small amounts may be present in the adhesive. I understand that the procedure requires that I lay still for up 3 hours or longer with my eyes closed, and that if I wear contacts, I must remove my contact lenses for the duration of the lash extension application or removal. I further state that I have no know medical condition that might be aggravated by the procedure or any medical condition that would prevent me from complying with or heeding to ELITE LASHES LLC/MODEL WANTED HOST instructions or these warning.
Initial No know medical conditions/ informed consent
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Clear Signature
Permission to use pictures
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I hereby grant ELITE LASHES LLC/MODEL WANTED HOST the full right to take, publish and reproduce photographs of me, my face, my eyes and/or eyelashes, both before and after the procedure, for any advertising, education, or other purposes whatsoever, including the right to retouch these photographs as deemed necessary by ELITE LASHES LLC/MODEL WANTED HOST . I further expressly assign any copyright in these photographs to ELITE LASHES LLC/MODEL WANTED HOST. I also grant my consent for ELITE LASHES LLC/MODEL WANTED HOST to use my images and likeness as contained in the photographs, along with any comments I may provide.
Initial Permission to use pictures
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Clear Signature
I wish to engage
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I have read and completed the Eyelash Extensions Intake & Consent form ELITE LASHES LLC/MODEL WANTED HOST in its entirety and have answered everything to the best of my ability. I have been informed of potentially harmful or negative side effects that may be caused by the application and/or removal of Eyelash Extensions. I confirm and agree that I wish to engage the services of MODEL WANTED FREE EYELASH MODEL FROM THE STUDENT to apply eyelash extensions.
Initial I wish to engage
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Clear Signature
Draw Your Full Name
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Clear Signature
By signing this consent form, I fully acknowledge that I am participating as a model in the EYELASH MODEL program hosted by the MODEL WANTED Facebook page. This session, which involves a student from the program performing procedures on my eyelashes, is provided free of charge. I understand that I am not required to pay anything to Elite Lashes LLC, and that none of the services are performed by Elite Lashes LLC directly. I agree to hold Elite Lashes LLC, along with its employees, harmless from any potential lawsuits. I commit not to leave any negative feedback regarding Elite Lashes LLC on their website or any other social networking platforms. As a participant of this free program provided by Model Wanted, I will direct any concerns or complaints to the individual with whom I scheduled my appointments.
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Clear Signature
Signed Date
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