Training/Class Name

Date(s)

Location

Full Legal Name

Phone

Email

Bloodborne Pathogens Certification (REQUIRED) Bloodborne Pathogens Certification (REQUIRED) I confirm that I have completed a Bloodborne Pathogens Certification course I understand this certification is required BEFORE starting any class involving needles

Date Completed

Proof Submitted Proof Submitted Yes No

Assumption of Risk Assumption of Risk I acknowledge that training may involve physical activity, cosmetic tools, medical-grade devices, needles, and potential exposure to blood or bodily fluids. I voluntarily assume all risks associated with participation.

Initials

Medical & Health Disclosure Medical & Health Disclosure I certify that I do not have any medical condition that would prevent safe participation. I agree to disclose any allergies, sensitivities, or medical conditions prior to training.

Initials

Limitation of Liability Limitation of Liability I release and hold harmless NitengaleDollz, its owner, instructors, employees, and affiliates from any claims, injuries, damages, or losses related to participation in training.

Initials

Scope of Practice Acknowledgment Scope of Practice Acknowledgment I understand that certain techniques taught may require specific licensure depending on state law. NitengaleDollz does not provide legal advice regarding scope of practice.

Initials

No Refund Policy No Refund Policy I understand that all class fees and deposits are non-refundable once training begins or materials are issued.

Initials

Photo & Video Consent Photo & Video Consent I consent to photos/videos I DO NOT consent

Participant Signature:

Date