U&I Spa Inc

130 West 57th Street, Suite 14A
New York, NY, 10019
Phone: 917.214.9910
Email: uandispa@gmail.com

Please answer all questions below and press the [SUBMIT] button on all forms.

1. CLIENT'S INFORMATION

*Do you have or previously had the following? Select YES or NO
I agree that all the above information is true and accurate to the best of my knowledge.


2. WAIVER OF LIABILITY AND GENERAL RELEASE

I, the undersigned (“Customer”), consent to have synthetic eyelash extensions attached to my natural eyelashes (the “Service”) by U&I Spa INC and his/her/its staff, assistants, contractors and employees (collectively herein, the “Service Provider”). The Service and its associated risks have been explained to me by the Service Provider in terms that I understand. The explanation included:

• The benefits of the Service;
• The nature of the Service and how the Service will be performed;
• The types of materials and adhesives used during the Service;
• The most frequently occurring risks of the Service, and those risks which are unlikely
to occur but which may involve serious consequences, including but not limited to the risk of experiencing: (a) Blepharitis and its associated symptoms, (b) an allergic reactions to the adhesive material used to attach the eyelash extensions to my natural eyelashes and to the synthetic eyelash material, (c) Traction Alopecia and its associated symptoms; (d) an eye injury due to synthetic and/or natural eyelashes falling on or into the eye; and (e) an eye or other injury occurring during the performance of the Service;
• How to properly care for the synthetic eyelashes applied during the Service; and
• How often I should expect to need to repeat the Service and the best methods for caring for the synthetic eyelashes after the Service is performed; and
• Factors that affect retention of eyelashes.

I was given the opportunity to ask the Service Provider any questions I have regarding the Service and I have had those questions answered to my satisfaction. Based on the foregoing, I hereby assume all of the risks associated with the Service, whether known or unknown, including, but not limited to, the risk of personal injury or property damage. As consideration for Service Provider performing the Service, I forever release Service Provider and his/her/its respective directors, officers, members, managers, employees, agents, contractors, attorneys, representatives, successors and assigns from any and all actions, claims, or demands that I, my assignees, heirs, next of kin, spouse, personal representatives and legal representatives now have, or may have in the future, for injury, death, or property damage, in any way related to the Service.

By initialing at the end of this paragraph, I grant Service Provider permission to reproduce, publish, distribute or otherwise use in any reasonable manner my name, photograph, likeness and statements, including, but not limited to, before and after pictures of my eyes and eyelashes in connection with the promotion of the Service or the products used in the Service (or other similar services and products) in all media, including without limitation, the internet, news articles, advertisements, or other electronic or printed materials. If my initials are not present at the end of this paragraph, then the above-described permission has not been granted.

3. FOR USE IF RELEASOR IS UNDER AGE OF 18

I, the undersigned parent or legal guardian of Releasor, have carefully read the foregoing Release, know and understand its contents and sign this Release on my and Releasor's behalf voluntarily as my own free act, with full knowledge of its significance, intending to legacy bind both myself and Releasor.

4. APPOINTMENT CANCELLATION POLICY

This document is to advise you of U&I Spa INC appointment cancellation policy. Due to the overwhelming demand for our services and limited appointment slots, it is critical that you provide us with notice if you wish to cancel your scheduled appointment. Having advanced notice allows us to fill the applicable appointment slot from the waiting list of others requesting an appointment.

If you need to cancel or reschedule your appointment with us for any reason (including events beyond your control), you must notify us as soon as possible and in any event before the close of business on the business day preceding your appointment.

Same day cancellations will be charged 50% of the scheduled service price. If you fail to show up for your appointment and fail to cancel that appointment by calling us prior to your scheduled appointment time, you will be charged a cancellation fee equal to 100% of the fees applicable to the service(s) you had scheduled.

Any guests that arrive more than 15 minutes late to an appointment may be subject to re-scheduling the service. By signing below, you acknowledge that you are subject to this policy and fully understand the cancellation policy.

Please be aware that discounted offers (Groupon, Living Social, Gilt, Class Pass etc) are only for first time clients (one-time use).

5. PHOTOGRAPHY RELEASE CONSENT

We would like your permission to use these photos for advertising. For example: Portfolios, online and print ads, etc. Your consent is necessary regarding this. Please circle and indicate with your signature if you would like your photos used or not used in advertising.