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Consent and Disclosure Form for Permanent Makeup
The nature and method of the permanent makeup procedure has been explained to me as having the usual risks inherent in the procedure and the possibility of complications during and following its performance. I understand there may be a certain amount of discomfort or pain associated with the procedure and that other adverse side effects may include minor and temporary bleeding, bruising, redness or other discolouration and swelling. Fading or loss of pigment may occur. Secondary infection in the area of the procedure may occur, however, if properly cared for, is rare.

I acknowledge by signing below, that I have been given the full opportunity to ask any and all questions which might have about obtaining of any permanent cosmetic procedures from Glaiza Capiral. I also acknowledge that all of my questions have been answered to my full and total satisfaction. I specifically acknowledge that I have been advised of the fact and matters set below, and agree as follows:


I grant authorization to the rights of my image and voice as recorded on audio and/or video. I waive any right to royalties or other compensation related to the use of my image. I understand that my image may be edited, copied, exhibited, published, or distributed via the Internet or in a public educational setting. I waive the right to approve the finished product wherein my likeness appears. This authorization extends to all languages, media, formats, and markets now known or later discovered.

Photograph and/or audio and video may be used for the following purposes:

* Website
* Marketing
* Portfolio
* Social Media

I give Glaiza Capiral, of Mayumi Beauty Lab
, permission to use my photos and videos as marked below:

Thank you!

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