First Name: _________________________ Last Name: _____________________



Date of birth: ______/__________/_________



Primary email address:______________________________________ Contract Date: ____________________



Mailing/Physical address: _____________________________________





Membership Program Type: _______________________________________ Member location: _________________________



Contract Period: _________________        Minimum Period: _________________



Mobile number:  __________________________________      Amount per week/contract period: $ ____/$_____



Next of Kin: (Name): ___________________________________________



Number: ____________________________________       Referred by: _______________________



Any operations, illnesses or injuries in the last 6 months?____________________________________ 



Any known Disorder or Condition?_______________________ Any previous reaction to an eye treatment? _______________________



Any allergies? _____________________________________




I,                                                 hereinafter referred to as (“I, me, my”) on  _____/________/___________ (date) enter into this Agreement by and between The Lash Stylist Pty Ltd which will be providing services (hereinafter referred to as “The Lash Stylist”). I have requested that The Lash Stylist provide me with beauty services, namely those pertaining to eyelashes and/or eyebrows, including application of artificial eyelashes to natural eyelashes, eyelash lifting of natural eyelashes, eyelash tinting of natural eyelashes, eyebrow henna, eyebrow waxing, and eyebrow tweezing(“the Service”), with such Service to be provided in consideration for a fee, and The Lash Stylist agrees to provide said service subject to my agreement to the following additional terms and conditions as follows:


1. Express Assumption of Risk


  1. Notwithstanding that The Lash Stylist will take all care and appropriate precautions in providing me with the Service, I acknowledge that before, during and after provision of the Service I mayexperience any and all of the following:

    1. irritation to the orbital eye area, including the eye itself, which could include, amongst other things, discomfort, itchiness, stinging or burning, blurry vision and, in rare cases, blindness;

    2. some irritation, itching or burning should the skin come into contact with the tinting agent;

    3. potential dark staining left on the skin.

  2. I understand that if I have allergies, medical conditions,am receiving treatment for a medical condition(s), am taking certain medications or have undertaken certain surgical or cosmetic procedures, by partaking in the services I may aggravate my medical situation: These conditions, treatments and medications include, but are not limited to the following:


  1. Allergies to adhesives (e.g. glues, band aids, tape);


  1. Treatment for chemotherapy within the last 6 months;


  1. Lasik surgery;


  1. Blephoroplasty;


  1. Alopecia or Trichotillomania;


  1. Psoriasis and similar skin conditions.


  1. I understand that if I have a medical condition or am taking certain medications, the effectiveness of the Service may be affected. These conditions or medications include:


  1. Alopecia or Trichotillomania;


  1. Psoriasis and similar skin conditions;


  1. Extremely oily hair or skin;


  1. Thyroid medications.


  1. Subject to this agreement, I understand that the Service is not permanent and will require maintenance by me.


  1. I understand that in partaking in the Service, I will need to keep my eyes closed for a duration of 30-180 minutes. I further understand that I will need to be lying in a reclined position. Any medical conditions that might be aggravated by lying still for a prolonged period of time may mean I will not be able to have the procedure performed on my eyes and/or eyebrows.


  1. I understand that if I am pregnant and there are any complications following partaking in the Service including, but not limited to, allergic reactions, a medical practitioner may not be able to prescribe me with certain medications.


  1. I understand that if I wear contact lenses glue used in provision of the Service may get underneath the contact lenses and cause corneal abrasion and/or scratching. Accordingly, I understand that it is my responsibility to remove my contact lenses prior to partaking in the service.


  1. I willingly assume full responsibility for the risks, including those contained in this agreement, that I am exposing myself to in participating in the Serviceand accept full responsibility for any injures that I may sustain in so participating. I am aware that this agreement is ongoing and will apply to all future occasions I participate in the services provided by Bronze Bombshell Beauty.


1.8           I acknowledge that I have no physical impairments, injuries, or illnesses that will endanger me or others and if I do I understand that

those illnesses or injuries may be aggravated by partaking in the Service. I represent that I am not aware of any medical or physical condition that would prevent me from partaking in the Service and if I am so aware I fully understand the risks associated in so partaking.


INITIALS ________________

  1. Membership and Service

2.1           I understand and acknowledge that the membership and the Service, subject to this agreement, entitles me to the following: application of artificial eyelashes to natural eyelashes, eyelash lifting of natural eyelashes, eyelash tinting of natural eyelashes, eyebrow tinting, eyebrow waxing, eyebrow threading and eyebrow tweezing.

2.2           I understand that, as holder of a 21 week membership I am, in addition to those services set out in clause 2.1, and subject to this agreement and availability, entitled to the selected number of Services, 10% off the price of a retail product.

2.3           I understand that to secure my preferred appointment time, irrespective of the service, I need to book my next appointment at the conclusion of my previous appointment. To that end, I understand that The Lash Stylist does not guarantee availability of my preferred appointment.

2.4           Rescheduling an appointment is accepted where another appointment time is available within the same week. To that end, I understand that The Lash Stylist does not guarantee me availability for rescheduling appointments.

2.5           I understand that if I fail to attend my appointment or cancel my appointment for any reason whatsoever or no reason, I am not entitled to a refund.

2.6           Ad hoc services, including, but not limited to, lash lifts, lash tints, may, depending on availability, be booked in advance or on the day of the appointment. I understand that these ad hoc services are payable on the appointment date, payment of which may be made by cash or visa/mastercard.

2.9           By mutual agreement between The Lash Stylist and I, my membership may be upgraded at any time.

2.10         I acknowledge that the Service is provided for a fee and that my participation as recipient of the Service is at my own free will.

INITIALS ________________

  1. Waiver

3.1           In consideration of my participation in the Service provided by The Lash Stylist, I, for myself, my heirs, executors, administrators or assigns, do hereby release, waive, discharge and covenant not to sue The Lash Stylist and/or its members, managers, officers, directors, agents, employees, and affiliated entities (Hereinafter referred to as “Releases”) from liability, from any and all claims, including any negligence of The Lash Stylist resulting in death, personal injury, accident or illnesses and property loss arising from, but not limited to, participation in the service and adherence to the programs provided by The Lash Stylist wherever located and by whomever provided.


INITIALS ________________



  1. Fees and Payments


4.1           In return for provision of the Service, I agree to pay:


  1. the Payment Fee set out in this agreement;


  1. regular payments by direct debit. I agree to notify The Lash Stylist  in the event of any payment detail changes including

bank account and/or credit/debit cards. After the end of the Minimum period, ongoing payments will continue until I terminate this agreement in accordance with the Termination clause herein.


4.2           I understand that it is my responsibility to ensure that sufficient funds are in my account in funds and to pay all of my own bank fees,

including fees which my bank has charged if my account is overdrawn as a result of a direct payment. If any direct payment fails The Lash Stylist will either add the outstanding sum to the next direct debit, or make additional direct debits to recover the outstanding amount. The Lash Stylist may charge a reasonable administration cost. If my account is more than 3 weeks in arrears, The Lash Stylist has the right to forward this agreement and my details to a debt collection agency or engage the services of a lawyer to recover its payment fees. I understand that should this occur,I am liable to pay The Lash Stylist legal fees and interest.


INITIALS ________________

  1. Suspension


  1. I may suspend my The Lash Stylist membership for a maximum of 6 weeks, due to holiday, work, illness or other circumstance, in which case I must provide written and in person notification of my suspension outlining the exact dates of the suspensions at least 14 days before the period requested.


  1. In accordance with clause 5.1, I understand that a backdated request cannot be made.


  1. In accordance with clause 5.1, I understand that a suspension request may incur an administration fee.


  1. Suspended weeks may be added to the end of the contract, with the discretion to do so resting exclusively with The Lash Stylist.


INITIALS ________________

  1. Cooling off period


  1. This agreement is subject to a 7 day cooling off period. I understand that if I wish to cancel this agreement within 7 days’of signing it, then I must do so in person.


INITIALS ________________


7. Cancellation/Termination


7.1           Subject to clause 6, this agreement remains in place for 21 weeks, to commence on the date of execution (‘minimum period’) The weekly fee which I pay The Lash Stylist reflects the contracted Minimum Period and is endorsed in this agreement. I understand that if I choose to terminate this agreement before the end of the Minimum Period, I must notify The Lash Stylist  in person. I further understand that I am liable for the balance of the Minimum Period. The Lash Stylist may bulk debit this sum from my debit account. Termination will be deemed effective from the start of the next billing period.


7.2           After the completion of the Minimum Period, a membership may be terminated with three weeks’ notice through a face-to-face meeting between the member and a representative from The Lash Stylist (‘exit consultation’). 


7.3           Memberships may only be terminated in accordance with clause 7.2 and, accordingly, phone and email cancellations will not be accepted.


  1.        Termination by The Lash Stylist


  1. I understand that, at any time, The Lash Stylist can terminate my membership and this agreement immediately by giving me notice in writing if:


  1. Ifail to pay fees liable to be paid under this agreement.

  2. due to my medical circumstances, it is untenable for me to continue partaking in the Service;

  3. due to any other reason, as decided by The Lash Stylist

  4.  I understand that the right to terminate on these grounds remains exclusively with The Lash Stylist and, even if such right is not exercised, I understand that The Lash Stylist is nonetheless entitled to recover its costs and losses under this agreement.


INITIALS ________________

8. Photography/Video/Marketing Release (Optional)

8.1           Participants involved in any activities offered by The Lash Stylist may be photographed or videotaped during provision of the service including online consultations. I hereby consent to the use of these photographs and/or videos without compensation, on the The Lash Stylist website, Facebook page or in any editorial, promotional or advertising material produced and/or published by The Lash Stylist both online and/or in print. I acknowledge that such photographs/video may include (but not limited to) “before” and “after” photographs.

INITIALS ________________

9. Severability and Jurisdiction

9.1           I further expressly agree that the foregoing provisions in this Agreement are intended to be as broad and inclusive as permitted by the laws of Western Australia, Australia and if any portion of this Agreement is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. I further acknowledge and agree that this Agreement shall be governed by and shall be construed in accordance with the laws ofWestern Australia, Australia.

INITIALS ________________

10. Indemnity

10.1         I recognise that there are risks involved in the services offered by The Lash Stylist. I therefore accept financial

responsibility for any injury that may be caused to me or to any other participant due to my negligence. Should the above mentioned parties, or anyone acting on their behalf, be required to incur solicitors’ fees and costs to enforce this agreement, I agree to reimburse them for such fees and costs.


INITIALS ________________

11. Payments & Billing

11.1         I hereby authoriseany and all payments due to The Lash Stylist by me.


11.2         I understand and acknowledge that payments made by me to Bronze Bombshell Beauty are processed through Stripe and I hereby authorize The Lash Stylist to convey information pertaining to me to Stripe for the purposes of my payment of the Service.


11.2         I authorise my credit card company or bank to make payment(s) to The Lash Stylist by the method(s) indicated via the direct debit form and to deduct such payment from my account. I understand that some payment periods may have less engagement and provision of service (due to public holidays) however the weekly fee will still be deducted - unless previously agreed upon by me and The Lash Stylist.


11.3         FOR BILLING QUESTIONS:  please email info@thelashstylist.com.au


INITIALS ________________

12. Acknowledgment of Understanding


12.1         I have read the Release of liability, waiver of claims and assumption of risk provisions in this Agreement and I understand that I am

giving up substantial rights, including my right to sue. I acknowledge that I am signing the Agreement freely and voluntarily and intend, by my signature that this document be a complete and unconditional release of liability to the greatest extent allowed by law. I further certify that I have fully read and understand the terms of this agreement and will comply with the contents herein.


Signature: _______________________________________Date: ______________