Henny Lash — Hengameh Arabmashaee & Thi Hong Van Bui
I authorize Hengameh Arabmashaee (artist & owner) and Thi Hong Van Bui (artist), also known as Henny Lash, hereinafter collectively referred to as "my artist," to perform semi-permanent eyelash extension procedures.
I understand this procedure requires individual synthetic eyelash fibers to be bonded to my natural lashes using professional-grade adhesive. I understand it is my responsibility to remain still during the application and to keep my eyes closed during the entire process until otherwise advised by my artist.
I acknowledge that my artist has explained to me the methods and procedures concerning the application of semi-permanent eyelash extensions, and that there are certain complications and risks inherent both in the application process and in wearing semi-permanent lashes. These risks may include, but are not limited to:
I hereby consent to the procedure at my own risk. If at any time I am uncomfortable with the eyelash extension procedure, I will inform my artist and she will use good faith efforts to rectify the problem, including ending the session if I or my artist wish. If my artist is uncomfortable applying lashes to me, she will discuss her concerns with me and may end the session if necessary.
I acknowledge that I have received no guarantees, warranties, promises, or commitments regarding the application process, the products used, or the results of this service.
I have revealed and disclosed to my artist all conditions and circumstances regarding my health and health history, medications being taken, and any past reactions to products used or medications taken. I understand that additional conditions could occur or be discovered during or after the procedure which could affect my ability to tolerate the procedure.
I understand that the longevity of my eyelash extensions depends on careful maintenance. Specifically:
I understand that failure to follow these instructions may cause irritation, allergic reaction, eyelash loss, and other side effects described in this form. These risks and aftercare requirements apply equally to initial applications and subsequent fill appointments.
I, the undersigned, hereby release, waive, covenant not to sue, and agree to hold harmless my artist, Hengameh Arabmashaee, Thi Hong Van Bui, and Henny Lash from any and all liabilities, demands, claims, losses, injuries, or damages of any kind arising out of or relating to the application of semi-permanent eyelash extension products, except to the extent caused by willful misconduct or fraud.
It is my express intent that this Waiver and Release Form shall bind the members of my family and spouse if I am alive, and my heirs, assigns, and personal representatives if I am deceased, and shall be governed by the laws of the State of California.
I agree that any dispute arising out of or relating to the application of semi-permanent eyelash extension products or the terms of this Waiver & Release shall be resolved by binding arbitration before the American Arbitration Association. The exclusive venue for arbitration shall be Orange County, California. Each party shall bear its own costs and attorney fees unless otherwise awarded by the arbitrator.
I further release my artist from any responsibility for pre-existing conditions I have not revealed, or any consequential changes to those conditions that arise after the procedure. I understand that I am responsible for any medical treatment I may need as a result of this procedure.
I acknowledge that no refunds are provided for services rendered. If I am not satisfied with my lash application, Henny Lash will fix it free of charge within 3 days of the initial appointment. In the event of an allergic reaction with visible signs of puffiness or discharge that prevents me from wearing eyelash extensions, removal will be provided free of charge within 3 days.
I, the undersigned client, certify that I have read, had explained to me, and fully understand the above Waiver and Release form and am signing it voluntarily as my own free act and deed. I accept the explanation of potential complications and risks described herein. I certify that I am at least 18 years of age, of sound mind, and fully capable of executing this Waiver and Release. No oral representations, statements, or inducements apart from the foregoing written agreement have been made.