12 Month Skin Care Membership

Name *

First Name

Last Name

DOB

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Application and Agreement Terms

1. *

I agree to be bound by the terms and conditions of the Secret Garden Skin Boutique and understand that The Secret Garden Skin Boutique accepts no responsibility for any accident, injury or misadventure suffered by members on the boutique premises howsoever caused, save only to the extent caused by the wilful default or negligence of the boutique. I confirm that I am aware that the terms and conditions and Treatment Plan (attached) form part of this agreement and that I have read and accept them;

Yes, I agree

2. *

I accept that the term and conditions may change periodically and I will be notified by email of any such changes:

Yes, I agree

3. *

I accept that there may be additional Disclaimers associated with certain treatments and they will form part of the terms and conditions of the agreement:

Yes, I agree

4. *

I accept that my Treatment Plan forms part of the terms and conditions of this agreement. I have read and accept the content of the Treatment Plan:

Yes, I agree