CLIENT CHEMICALRELEASE FORM
DATE: _____________________________
I, ___________________________________, release __________________, and
(client)(salon)
Stylist/Colorist _____________________________, from any responsibility and/or
(stylist)
liability concerning the application, processing and/or consequences of the permanent chemical procedure of my hair. I consent to have _________________________________, a permanent chemical process,
applied to my hair.(service)
I release __________________, its employees and its agents harmless against any and all liability,
damage, and/or expenses arising out of or in connection with actions, claims, and/or damages resulting in personal injuries and disabilities (physical and/or psychological) that I might incur as a result of the chemical altercation through permanent chemical processing of my hair. I understand that additional conditioning treatments may be recommended and/or necessary for my hair maintenance and that permanent damage to my hair is possible due to the chemical application.
______________ (client initials) I have not had any chemical process performed on my hair within the last
six weeks.
______________ (client initials) I have had _____________________ chemical process performed on my
hair within the last six weeks.
Explain: ______________________________________________________________________________
The approximate costs of the permanent chemical services that will be used on my hair are as follows:
|  | PERMANENT WAVE | $ ___________ |   | 
|  | RELAXER/STRAIGHTENING | ___________ |   | 
|  | Due to the past history and | 
|  | COLOR/HILIGHTING | ___________ | condition of your hair, we | 
|  | HAIRCUT | ___________ | cannot honor our two-week | 
|  | guarantee. However we will | 
|  | CONDITIONING TREATMENTS | ___________ | perform any adjustments for a | 
|  | charge. | 
|  | POSSIBILITY OF EXTRA SERVICES | ___________ | 
|  | Client Initials: ___________ | 
|  | TOTAL OF SERVICES | $ ___________ | 
|  |   | 
|  |   |   |   | 
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