New Client Registration

Name *
Address *
Birthday *
Able to lay on your back for 23 hours? *
Are you pregnant or planning to be? *
Prior eyelash extension procedure? *
Do you wear contact lenses? *
I Understand: *
Sleeping on my face, extreme weather changes, steam, sauna, and other activities may damage the adhesive or crimp the extensions and may require more frequent refills. I reviewed and understand the aftercare instructions and will do my part to help maintain my eyelash extensions.
I Understand: *
I understand that eyelash extensions require ongoing maintenance (similar to a nail rebase) and that refill fees are based on time and / or the number of extensions that need to be replaced at the refill appointments. If I wait too long between Refills, I may need to pay for a new full set. If I no longer wish to wear the eyelash extensions, my technician will remove them and I will not try to remove them myself and there may be a fee for removal of the eyelash extensions.
I Understand: *
I will seek medical care (at my own expense) and contact Wakeup In Makeup immediately if any allergic or adverse reaction occurs. All of my questions were answered and I understand the procedure and risks.
I Understand: *
I release Wakeup in Makeup from any and all liability associated with this procedure (which will be performed with the utmost attention to safety and proper application using tools and products that the Technician has been trained to use. This procedure has many variables due to lifestyle, moisture, weather, extreme temperatures, natural eyelash shedding, and other factors. The Technician will assess and decide if I am a candidate for this service to the best of their ability. No guarantees are made or implied.
I grant permission: *
I grant permission to use my before and after photos for marketing or examples of my technicians work. (Before and after photos are a permanent part of the Technician’s records. You may opt out of marketing purposes)
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Today's Date *
Today's Date