G.A.S Barbershop & Hair Salon
Chemical consent form

I am aware and understand that receiving any hair color service, in some individuals, can cause an allergic reaction. Chemical services are based on the individual’s hair. I’ve made the stylist aware of all chemical services that have been preformed. I’ve also made the stylist aware of all medications I am taking. I realize that this is very important information and that potential for unpredictable chemical reactions. Chemical processes may cause some damage to the integrity of the hair. There are products recommended to improve the health of my hair as well as maintain the results after the service. I will not hold G.A.S Barbershop & Hair Salon if the process has unexpected or undesired results.

I, the undersigned, assume all risks and hazards incidental to participating in the activity and do herby waive, release, absolve, indemnify and agree to protect,
defend G.A.S Barbershop & Hair Salon, their owner, staff and participants for any claim
arising out of any injury to myself/child to the fullest extent allowed by law. I, the undersigned, am fully aware of the potential dangers and risks inherent in this activity, including physical injury, death or other consequences that may arise or result directly or indirectly from participation in all Salon activities.



Consent for minors (if not applicable, fill in "NA") Electronic signature *
Your answer
List of allergies (if none, fill in "none") *
Your answer
List of medications (if none, fill in "none") *
Your answer
Date *
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YYYY
Electronic signature *
Your answer
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