Hair Chemical Service Liability Waiver Form
Complete this form to acknowledge and accept the terms and conditions for receiving hair chemical services.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Service
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Type of Chemical Service
*
Please Select
Color (Permanent/Semi-Permanent)
Highlights/Balayage
Perm/Relaxer
Keratin/Smoothing Treatment
Other
Please list any allergies or sensitivities relevant to hair products (if none, enter 'None'). Do not include sensitive health details.
*
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Stylist Name
*
Signature
*
Submit Waiver
Submit Waiver
Should be Empty: