The Masterton and South Wairarapa District Councils’
Consolidated Bylaws 2012: Part 15 - Beauty Therapists, Solarium
Operators, Nail Technicians, Tattooists and Skin Piercers
Health Act 1956, Local Government Act 2002
FORM
Application for Beauty Therapists, Solarium
Operators, Nail Technicians, Tattooists and
Skin Piercers Certificate of Registration
Fill this form out with assistance from to the Beauty Therapists, Solarium Operators, Nail technicians, Tattooists and and Skin Piercers Registration Guide.
1. Applicant details
1a. Applicant name:
Full name of applicant(s) or company
1b. Postal address:
1c. Contact numbers:
1d. Email:
1e. Manager’s Name:
Phone ( ) Mobile ( )
2a. Premises address:
2b. Premises contact number:
2c. Vehicle details:
(if mobile premises)
Make and model of vehicle Registration number
2d. Trading name:
2e. Proposed Opening Date or
Take over the business:
Day Month Year
2. Business details
Phone ( ) Mobile ( )
/ /
3a. Type of licence: New New operator of existing registered premises
3b. Type of Premises:
Commercial Residential
Mobile
3c. Type of operation: Permanent
Temporary Start date: End Date:
3d. Principal business conducted: Beauty therapy Tattooing Solarium Operator
Skin piercer Nail Technician
Other
Masterton District Council
161 Queen St
PO Box 444
Masterton 5840
Telephone: 06 370 6300
Fax: 06 378 8400
Email: mdc@mstn.govt.nz
3. Registration details
/ /
/ /
K:\Health\Beauty Therapists-Nail Technicians\Application for Beauty Therapy etc.doc
K:\Health\Forms\Word Documents\Application for Beauty Therapy etc.doc
I understand that the Council will send all invoices for Licence fees and all correspondence related to
the application to the Licence holder.
I confirm that I have read and understood the privacy statement above and that the information provided
on this application form is true and correct.
5. Applicant’s declaration
3e. Tick all procedures carried out on premises (or attach a full service menu for your premises):
Hairdressing
Exfoliation
Eyebrow & eyelash tinting
Acupuncture
Skin peel (glycolic)
Eyebrow tattooing
Ear piercing
Botox/fillers
Eyebrow shaping
Face/body piercing
Collagen replacement
Eyelash perming
Sun bed/solaria
Laser procedure
Eyelash extensions
Sauna/spa pool/steam room/wet bed
Red vein treatment (non-laser)
Manicure
Temporary hair removal
Spray tan
Pedicure
Tattooing/pigment implantation
Waxing
Nail augmentation
Cultural tattooing including
Skin care treatment
Massage
Kaitaamoko/tatau/uhi (facial/make-up)
Electrolysis (Epilation/depilation/diathermy)
Other
3. 3. Registration details (continued)
I understand that the council will send all invoices for registration fees and all correspondence related to the
application to the certificate holder.
I confirm that I have read and understood that the information provided on this application form is true and correct.
Signature Date
OFFICE USE ONLY
NCS No.
Approved Date / / Declined Hold
Conditions to be imposed: Yes (list on separate sheet) No
Category classification:
Beauty Therapy
Tattooing
Skin Piercer
Solarium Operator
Nail Technician
Other
Registration fee:
No charge
Sole business
Secondary business
EHO Planning Approval Yes No
Building Approval Yes No
Premises inspection date: Inspected by:
/ /
/ /
4. Premises Plan
Provide a scale floor plan (e.g. 1:50) of the proposed premises showing the layout, fittings and fixtures,
detailing all floor, wall and ceiling surfaces and essential features
Explanations in this guide are intended to assist you to complete the Beauty Therapists, Solarium Operators, Nail Technicians,
Tattooists and Skin Piercers Certificate of Registration Form. The numbers on the form relate to the explanatory notes in this guide.
The Masterton and South Wairarapa District Councils’ Consolidated Bylaws
2012: Part 15 - Beauty Therapists, Solarium Operators, Nail Technicians,
Tattooists and Skin Piercers
Health Act 1956, Local Government Act 2002
G
UIDE
Application for Beauty Therapists, Solarium Operators,
Nail Technicians, Tattooists and Skin Piercers
Certificate of Registration
Masterton District Council
161 Queen St
P O Box 444
Masterton 5840
Telephone: 06 370 6300
Fax: 06 378 8400
Email: mdc@mstn.govt.nz
1. Business details
Background
The Masterton and South Wairarapa District Councils
Consolidated Bylaws 2012: Part 15. Beauty Therapists,
Solarium Operators, Nail Technicians, Tattooists and
Skin Piercers requires owners or operators of all such
premises
(including mobile or temporary premises) to
apply for a certificate of registration if they intend to use a
premises for the purposes of a prescribed process.
The purpose of the bylaw is to protect, promote and
maintain public health and safety where a risk of
transferring communicable diseases may exist.
In order to obtain a certificate of registration the premises
must comply with the standards and requirements set
down in the bylaw and all other relevant legislation or
standards.
Renewal and registration fees
Registrations are renewed annually.
Application fees are payable upon renewal. Fees are
reviewed annually in the Annual Plan for each council.
1. Applicant details
1a. Applicant name
The person or company applying for the registration.
1b. Postal address
Address for all correspondence to you from the Council.
2. Business details
2a. Premises address
Write the full physical address of the premises
which the application relates to.
Specify the unit number and street name.
2b. Premises contact number
Provide the contact number of the premises.
2c. Vehicle details
For mobile premises, provide the make and model
of vehicle and registration number.
2d. Trading name
New/current trading name provide the trading name
that you currently or intend to use for the premises.
Previous trading name provide the previous trading
name of the premises if any.
2e. Take-over date
State the date you intend to open/take-over the
business.
3. Registration details
3a. Type of licence
Tick ‘newif the premises are not
currently registered for beauty therapy,
tattooing, solaria or skin piercing.
Tick ‘new operator of existing premises’
if a registration already exists for this
premises, and a new operator intends
to take over the business.
Tick ‘renewal’ if you are applying for
renewal of your existing registration.
Amend any details that need updating.
3b. Type of premises
Tick the type of premises where the business will be
operating from:
‘commercial’ from a commercial premises,
industrial premises or community building;
‘residential’ from a private dwelling;
‘mobile’ where procedures are carried out at
a clients premises or on a mobile basis.
K:\Health\Beauty Therapists-Nail Technicians\Guide for Beauty Therapy etc.doc
3c. Type of operation
Tick the option that best describes the
frequency the operation is carried out in
the premises.
Permanent means the procedures may be
carried out all year round in the premises.
Temporary means the procedures are carried
out in the premises on a temporary basis. You
need to provide the start date and end date of
the operation.
3d. Principal business conducted
Tick the principal activity of your business.
Where the options do not include your
principal business, please supply the
nature of your principal business activity.
Beauty therapy means any prescribed
procedure intended to improve, alter or
cleanse a person’s hair, skin or complexion,
including waxing, hair removal, tinting,
electrolysis, facials, body therapy and
massage, laser procedures, glycolic peels,
extractions, manicure or pedicure procedures,
nail augmentation, commercial sun beds,
saunas, spas or steam rooms or red vein
treatment.
Tattooing means the practice of making
indelible (permanent) marks in human skin or
tissue by inserting pigments or dyes into
punctures made in the skin or tissues.
Tattooing shall also include the process known
as pigment implantation.
Solarium Operator means providing UV
tanning beds or both for cosmetic purposes.
Skin piercing involves the piercing, cutting or
puncturing of the skin or any other part of the
human body, for the purpose of jewellery,
tattooing, acupuncture, epilation (including
electrolysis and waxing), red vein
cauterisation, pedicure and manicure.
Nail Technician means practice of nail
augmentation, manicure or pedicure.
3e. Procedures performed
Tick all procedures carried out in your
business.
Exfoliation means treatment that removes
dead skin cells from the outer layer of the
epidermis (skin).
Eyebrow and eyelash tinting means the
tinting of eyebrows or eyelashes to provide
additional colour to brows/lashes.
Acupuncture means the practice involving the
insertion of needles through the skin and
tissue for the purposes of alleviating ailments
or injuries.
Skin peel (glycolic) is the application of alpha
hydroxy acids, including glycolic acid, to the
skin of the face causing dead skin to peel off.
3. Registration details……continued
Botox means treatment using a wrinkle-smoothing
product made from Botulin Toxin A. A highly
diluted form of the toxin taken from the bacteria
that causes Botulism is injected into specific areas
of the face or body.
Eyebrow shaping may involve the waxing or
plucking and tidying-up of eyebrows.
Collagen replacement means a treatment where
Collagen, a natural protein, is injected into the face
to aim to smooth out facial lines, plump up lips and
generally improve the appearance of the skin.
Eyelash perming means the permanent curling of
eyelashes.
Eyelash extensions means extension of
eyelashes by individually applied synthetic lashes.
Manicure involves the shaping of a client’s nails,
tidying the nail cuticles, moisturising the hands
and nails, massaging the hands and arms and
buffing the nails or applying nail enamel.
Red vein treatment means a specialised form of
electrolysis that helps to remove unsightly red
veins that may be present on the face or body,
and can include removal of skin tags
(acrochordon).
Pedicure means the treatment or beautification of
feet by the puncturing or removal of layers of skin
or tissue. The soaking of feet in tepid water,
clipping and/or filing of the toe nails and/or the
removing of hard skin on the balls of the feet or
heels.
Temporary hair removal either by wax (hot or
cold) or a process known as sugaring (pliable
sugar paste).
Nail augmentation means the process of applying
artificial nail extensions. These may be made from
acrylic, gel, silk or fibreglass.
Massage is the manipulation of superficial and
deeper layers of muscle and connective tissue to
enhance their function and promote relaxation and
well-being.
Cultural tattooing means Kaitaamoko,tatau,uhi or
other traditional significant tattooing practice.
Skin care treatment includes manual facial
treatment which involves the use of cleansing,
toning and moisturising preparations followed by
soothing facial massage.
Epilation or depilation means the practice
Involving the penetration of the skin for the
purpose of removing hair and includes the process
commonly known as electrolysis.
Electrolysis or short-wave diathermy means the
use of negatively charged electrical current to
destroy hair.
Chemical hair removal means removal of body or
facial hair by use of a gel, lotion, powder or spray.
K:\Health\Beauty Therapists-Nail Technicians\Guide for Beauty Therapy etc.doc
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