How to word my hair salons Release of Liability Form for people wanting serviced that could damage their hair?

For example, if someone comes in with really fried hair and wants a perm. My stylists will tell them they should not do it because their hair may break off because it is so fried. If the customer insists, my stylists will do it, but we want them to sign some kind of form that says they were told of the dangers and that they decided to have the service performed anyways. Something that will state that we are totally not liable for anything that might happen?How to word my hair salons Release of Liability Form for people wanting serviced that could damage their hair?
IT SHOULD SAY SOMETHING LIKE:





';CUSTOMER HAS BEEN ADVISED TO SEEK ADVICE FROM A MEDICAL PROFESSIONAL REGARDING ALL CHEMICAL, PHYSICAL, AND MEDICAL CONSEQUENCES WHICH COULD RESULT FROM THIS SERVICE PERFOMED, AND IN DOING SO, RELEASES %26lt;BIZ NAME, OR STYLIST NAME%26gt; OF ANY AND ALL LIABILITY IN CONNECTION WITH THIS PERM.';





HOPE THIS HELPS.