Child Consent Form

Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

By entering your phone number, you are agreeing to receive text messages from us. You can reply STOP to opt-out.

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Have you shaved within 10 days of your appointment date?

Yes and I understand that some hairs may be missed if they are too short.

No

Are you currently using or have you used any of the following in the past 7 days?

Check all that apply.

Alpha Hydroxy Acid (AHA)

Skin Thinning Products

Glycolic Acid

Scrubs, Peels, or Exfoliators

Tanning Beds

Retin A

Resorcinal

Do you have tendencies towards any of the following?

Check all that apply

Ingrown Hairs

Hyperpgimentation (skin darkening)

Eczema

Breakouts

Bruising

Psoriasis

Bumps

Scarring

Are you taking Accutane (or similar) or have you in the past year? *

Brand names include: Accutane, Claravis, Sotret, Accutane, Amnesteem, Myorisan

Yes

No

Accutane Warning: *

Using retinoids (accutane or similar) can cause skin to rip off during the waxing process. For your own safety, we cannot wax you until you have been off of Accutane or similar medications for over a year's time.

I understand the dangers of Accutane. Should I decide to take Accutane in the future, I will inform my aesthetician and will not get waxed or sugared at Hello Sugar LLC at any time within one year of taking the medicine.