Event Information

Event name

Event date

Event timeoptional

Child’s full name

Child’s date of birth

Age

Parent/natural guardian’s name

Mobile phone

Emergency contact and phone

Authorized pickup person, if differentoptional

Activity Consent

I authorize my child to participate in the activities checked below:

Polish application to fingernails
Age-appropriate makeup application
Optional mini facial when included with the selected birthday package
Face gems or cosmetic adhesive decorations
Temporary hair accessories or clips
Bracelet, charm, or craft activities
Food, sweets, or nonalcoholic beverages
Group games, music, and a runway-style photo session with props

A child may decline or stop any activity at any time. Declining an activity will not result in pressure, punishment, or embarrassment.

Allergies, Sensitivities and Health Information

Please disclose any skin sensitivity, eczema, active rash, open wound, eye irritation, communicable illness, head lice, or other circumstance that could affect safe participation

I understand that House of Rose may modify or decline an activity when staff reasonably believe participation may be unsafe or inappropriate.

Nature of the Experience

I understand that Little Roses is a recreational entertainment experience. Activities provided during the event are cosmetic, creative, and non-medical. An optional mini facial may be included when selected as part of an eligible birthday package and is performed by an appropriately licensed House of Rose professional.

Little Roses does not provide medical care, dermatological treatment, therapy, childcare, or advanced aesthetic services to participating children. No injections, prescription products, powered aesthetic devices, exfoliating treatments, permanent cosmetics, skin resurfacing, hair removal, lash services, or invasive procedures are included.

Product and Activity Risks

I understand that participation may involve risks including:

Skin irritation, sensitivity, or allergic reaction
Eye irritation from cosmetic products
Temporary staining of skin, hair, nails, or clothing
Slips, trips, or falls
Contact with furniture, decorations, craft materials, or other participants
Choking hazards from food, beads, charms, or small decorative items
Incidental cuts, scratches, or other minor injury
Exposure to a communicable illness in a group environment

I confirm that I have disclosed relevant allergies, sensitivities, health concerns, and support needs. I understand that no cosmetic product can be represented as risk-free for every child.

Health and Conduct Certification

I certify that my child is well enough to participate and is not currently experiencing fever, vomiting, a contagious illness, an active eye infection, head lice, or an unexplained rash.

I understand that House of Rose may end my child’s participation if the child becomes ill, behaves unsafely, or is unable to follow reasonable safety instructions. The parent, guardian, or designated responsible adult remains responsible for the child’s supervision and timely pickup.

House of Rose staff will not administer medication.

Emergency Authorization

If an urgent situation occurs and I cannot be reached promptly, I authorize House of Rose Aesthetics LLC to contact emergency services and seek reasonably necessary emergency assistance for my child.

I understand that House of Rose does not provide medical treatment and that I remain financially responsible for medical services provided by third parties.

Notice to the minor child’s natural guardian

Read this form completely and carefully. You are agreeing to let your minor child engage in a potentially dangerous activity. You are agreeing that, even if House of Rose Aesthetics LLC and its owners, affiliates, employees, and agents use reasonable care in providing this activity, there is a chance your child may be seriously injured or killed by participating in this activity because there are certain dangers inherent in the activity which cannot be avoided or eliminated. By signing this form you are giving up your child’s right and your right to recover from House of Rose Aesthetics LLC and its owners, affiliates, employees, and agents in a lawsuit for any personal injury, including death, to your child or any property damage that results from the risks that are a natural part of the activity. You have the right to refuse to sign this form, and House of Rose Aesthetics LLC has the right to refuse to let your child participate if you do not sign this form.

I voluntarily accept the inherent risks associated with the selected activities and release House of Rose Aesthetics LLC and its owners, affiliates, employees, and agents only to the extent permitted by Florida law. This agreement does not waive claims that cannot lawfully be waived.

Optional Photo and Media Permission

Please select one:

Yes. I authorize House of Rose Aesthetics LLC to photograph or record my child and use selected images in its website, social media, advertising, and printed materials without compensation.
Private sharing only. Images may be shared directly with event families but may not be used publicly by House of Rose.
No. I do not authorize photographs or recordings of my child.

Declining public photo permission will not affect the child’s ability to participate.

Acknowledgment and Signature

I confirm that I am the child’s parent or natural guardian and have authority to complete this agreement. I have read the entire form, understand its terms, and have had the opportunity to ask questions.

I am the child’s parent or natural guardian, I have read this entire agreement, and I intend the name I type below to be my signature.

Signature — type your full name

Date and time

House of Rose representative:

Agreement completed

Signed and ready.

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