Body Piercing Release Form
I hereby certify that I am choosing to obtain a body piercing, jewelry insertion, or jewelry removal from Prysm Jewelry & Piercing under my own free will, and that I am not under the influence of any other person to do so, nor am I under the influence of any type of drug or alcohol. I understand all of the potential short and long term risks involved in body piercing, jewelry insertion, jewelry removal, the procedure and aftercare. I Agree I grant permission to a professional body piercer to pierce my body and insert or remove jewelry. In consideration of their doing so, I hereby release Prysm Jewelry & Piercing, its owner(s), employees, and agents from all manner of liabilities, claims, actions and demands, in law or in equity, which I or my heirs have or might have now or hereafter by reason of complying with my request to be pierced, jewelry inserted, or jewelry removed. I Agree I understand that the procedure(s) will be performed with appropriate instruments and techniques. To ensure proper healing, I agree to follow the aftercare procedures outlined to me, until healing is complete. I understand that the body piercer, in performing a piercing, insertion or removal does not act in the capacity of a medical professional. Any and all suggestions made by the piercer are solely suggestions and not a substitute for advice from a medical professional. I Agree In the event that photographs are taken, I hereby give Prysm Jewelry & Piercing, its employees, or agents permission to copyright and/or use, and/or publish images of me and/or my piercing. This includes reproductions made through any media format, or for any other lawful purpose whatsoever. I waive any right I may have to inspect the photograph and/or approve the finished product or the use to which it may be applied. I Agree I will notify my Body Piercer at Prysm if I have any allergies (other than medications or environmental). I Agree I consider myself healthy enough to receive and heal this piercing. I Agree Covid-19 Assumption of Risk
The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. Prysm Body Piercing (“the Facility”) has put in place preventative measures to reduce the spread of COVID-19; however, infection from COVID-19 can happen anywhere and no business can guarantee or completely prevent someone from becoming infected. Further, being in any business could increase your risk of contracting COVID-19.
I Agree To prevent the spread of contagious viruses and to help protect others, I understand that I will have to follow the facility’s guidelines. The facility’s guidelines can be changed at anytime as new information and technology become available. I Agree I confirm that I am not presenting any of the symptoms of COVID-19 including: dry cough, running nose, sore throat, shortness of breath, loss of sense of taste or smell, fever - body temperature of 100.4 ºF or more. I Agree I confirm that I have not been in close contact with anyone with these symptoms or anyone who has been diagnosed with COVID-19 in the past 14 days. I Agree I understand and agree that this release of liability includes any claims based on the actions, omissions, or negligence of the facility, its employees, agents and representatives, including if a an infection or illness occurs before, during or after receiving services within the facility. I Agree I declare under penalty of perjury, under the laws of the United States of America that the foregoing is true and correct.
October 29, 2024
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