Model Intake Form

MODEL QUESTIONNAIRE

You may not be suitable to receive eyelash extensions if you answer “Yes” to any of the questions below. If answered "Yes", the explanation below each question should be thoroughly read.

At the Training Program, we expect that you will have some length and volume added to your eyelashes, but please be aware that we cannot guarantee that you will receive a full set of lash extensions.

NOTICE: Minimum age for models is 13 years of age. A parent or legal guardian must give written consent for Minors from 13-17 years of age to participate as a model.

Are you over 18 years of age?

Yes No

You must be at least 13 years old to be a model, with the consent of your parent or legal guardian. Are you 13 years or older?

Yes No

Do you wear eyelash extensions?

Yes No

Eyelash extensions must be removed at least 48 hours before your application session.

I agree to having my Eyelash extensions removed prior to the date of my modeling session.

Do you wear contacts?

Yes No

Contact lenses cannot be worn during the application and for the first 3 hours after the application. Please bring glasses to your application session. If you wear hard contact lenses designed to reshape your cornea, please wait until they can be removed prior to becoming an eyelash extensions model.

I agree to bring glasses with me to my modeling session. If I wear hard contact lenses designed to reshape my cornea, I will have them removed prior to my modeling session.

Do you have any known allergies to acrylates?

Yes No

You are not a suitable candidate for eyelash extensions applications or for being a model at eyelash extensions training programs. Adhesives used to apply eyelash extensions contain acrylates.

Do you have any known allergies to long-wearing cosmetics, waterproof cosmetics, and/or nail adhesives?

Yes No

You are not a suitable candidate for receiving eyelash extensions or for being a model since you may have an undiagnosed allergy to acrylates, which are found in eyelash extensions adhesives, long- wear cosmetics, and nail adhesives.

Do you have any known allergies to aloe or coconuts?

Yes No

You are not a suitable candidate for being an eyelash extensions model at this time since the Eye Makeup Remover & Facial Cleanser used prior to lash applications at our training programs contains aloe and coconut-based ingredients. There are no substitute cleansers available at the training programs at this time. We encourage you to visit your local Xtreme Lashes Lash Stylist since they may be able to use a substitute cleanser.

Do you suffer from severe allergies and/or carry an allergy pen?

Yes No

You are not a suitable candidate for being an eyelash extensions model since you may be allergic to one or more ingredients in the products used throughout the application process. There are no substitute cleansers available at the training programs at this time. We encourage you to visit your local Xtreme Lashes Lash Stylist to determine if you are a suitable candidate for eyelash extensions application since they will conduct a comprehensive pre-application consultation to ensure you are not allergic to any of the products used.

Do you have any problem lying down with your eyes closed for 2.5 to 3 hours OR are you claustrophobic?

Yes No

You must be able to lie down with your eyes closed for up to three (3) hours during the eyelash extensions application.

I will be able to lie down with my eyes closed for up to three (3) hours during my modeling session.

Have you recently had any facial skin resurfacing, invasive cosmetic treatments, eye surgeries, or procedures?

Yes No

Please ensure that you have fully recovered from any treatments/procedures prior to becoming an eyelash extensions model.

I will ensure to be fully recovered from any treatments/procedures prior to my modeling session.

Do you have any known eye infections?

Yes No

Currently, you are not a suitable candidate for being a model at eyelash extensions training programs. Please ensure any eye infections have been treated and resolved by receiving clearance from your physician before applying to become a model at eyelash extensions training programs or receiving eyelash extensions.

I will ensure any eye infections have been treated and resolved by receiving clearance from my physician before attending my modeling session.

Do you have any known eye disorders?

Yes No

Depending on your eye disorder, you may not be able to receive eyelash extensions. Please receive clearance from your physician before applying to become a model at an eyelash extensions training program or receiving eyelash extensions. If you are not able to receive clearance, then you are not a suitable candidate for modeling at eyelash extensions training programs. After receiving clearance from your physician, we encourage you to visit your local Xtreme Lashes Lash Stylist to determine if you are a suitable candidate for eyelash extensions application since they will conduct a comprehensive pre-application consultation.

I will receive clearance from my physician before my modeling session.

Are you pregnant?

Yes No

Note that although Xtreme Lashes is not aware of any pregnancy risks associated with the application of eyelash extensions, we recommend that pregnant women consult with their medical provider prior to receiving eyelash extensions.

I have consulted with my medical provider and received clearance to receive eyelash extensions prior to my modeling session.

Model Terms & Conditions have been sent to the email provided.
Please complete this agreement and press the button below after you have signed the agreement.

Model Sign-up

MODEL QUESTIONNAIRE

Unfortunately, you do not qualify to be an Xtreme Lashes Model