Chemical Service Waiver
Chemical Service Waiver
I. Agreement to Proceed
This Chemical Service Waiver ("Waiver") is executed between [YOUR SALON OR BUSINESS NAME] ("Service Provider") and [CLIENT'S NAME] ("Client"). This document serves as formal consent by the Client to receive chemical treatment services, and it outlines the Client’s understanding of the associated risks and agreement to proceed under the terms provided.
II. Description of Chemical Service
[CHEMICAL SERVICE] to be performed at [YOUR SALON OR BUSINESS ADDRESS] on [DATE OF SERVICE]. The service involves the use of chemicals which may include, but are not limited to, [LIST OF CHEMICALS USED]. These chemicals are commonly used for [DESCRIPTION OF PURPOSE, e.g., permanent coloring, straightening, or curling].
III. Acknowledgment of Risks
The Client acknowledges and understands that there are risks associated with the application of chemical treatments to hair and skin, which may include, but are not limited to, allergic reactions, hair breakage, hair loss, and burns. The Client affirms that:
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They have informed the Service Provider of all known allergies and previous reactions related to chemical treatments.
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They have consulted with the Service Provider and have been advised on the suitability of the chemical treatment for their hair and skin type.
IV. Client Consent
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Voluntary Participation: The Client confirms that they are electing to undergo the chemical service voluntarily and have been offered the opportunity to ask any questions regarding the service and its effects.
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Release of Liability: The Client agrees to release and hold harmless [YOUR SALON OR BUSINESS NAME], its employees, and agents from any claims, damages, or liabilities arising from the chemical service.
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Informed Consent: The Client states that they have been fully informed of the potential effects and risks, and consent to the treatments as described.
V. Pre-Procedure Confirmation
The Client has completed a patch test on [PATCH TEST DATE], and no adverse reactions were recorded. This test was performed to assess the Client’s sensitivity to the chemicals intended for use.
VI. Client Declaration
The Client declares that the information provided to the Service Provider is accurate to the best of their knowledge and that they have not withheld any relevant health or medical information that could affect the outcome of the treatment.
VII. Legal Binding
This Waiver is binding upon both parties and shall be governed by the laws of [STATE NAME]. Any legal claims or disputes shall be settled in the jurisdiction where [YOUR SALON OR BUSINESS NAME] is located.
VIII. Signatures
Both the Client and the Service Provider must sign this Waiver to acknowledge their understanding and acceptance of its terms.
Service Provider’s Signature:
[YOUR NAME]
[YOUR TITLE/POSITION AT YOUR SALON OR BUSINESS NAME]
Date: [SIGNATURE DATE]
Client’s Signature:
[CLIENT'S NAME]
Date: [SIGNATURE DATE]
