At Home Color Kit Release Form

3010 w 111th Street
Chicago, IL 60655
vierhairloft@gmail.com
(708) 407-5626
This form is for the legal release of liaility from VIER HAIR LOFT, LLC from any adverse reactions, claims, damage, or loss of any kind that could happen as a result of use /misuse of the At Home Color Kit.
Order Date
YearMonthDay
Date
Pick Up Date
YearMonthDay
Date
I hereby authorize VIER HAIR LOFT, LLC to formulate and prepare my custom root touch up kit and/or gloss for me to apply at home during this pandemic.
I am aware that this form releases the company and service provider from any liabilities and claims. I fully understand the terms and conditions under this agreement.
Name
First NameLast Name
Phone Number
Area CodePhone Number
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Client Signature
Limpiar
Client Printed Name
Please refer to the Intstructional Form for application details.
For any further questions, please contact Bianca directly at (708) 407-5626
be kind to yourself.
-Jon Acuff
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