Waiver of Liability Relating of Coronavirus/COVID-19 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. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. Chameleon Tattoo and Body Piercing have put in place preventative measures to reduce the spread of COVID-19; however, Chameleon Tattoo and Body Piercing cannot guarantee that you will not become infected with COVID-19. Further, getting a tattoo or piercing could increase your risk of contracting COVID-19. ------------------------------------------------------------------------------------------------------------------------------- By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19 by entering Chameleon Tattoo and Body Piercing and that such exposure of infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 may result from the actions, omissions, or negligence of myself and others, including , but not limited to, Chameleon Tattoo and Body Piercing employees. I voluntarily agree to assume all of the possible risks and accept sole responsibility for any injury to myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I may experience or incur in connection with my attendance at Chameleon Tattoo and Body Piercing. I hereby release, discharge, and hold harmless Chameleon Tattoo and Body Piercing LLC, its employees, agents, of and from the Claims, including all liabilities, claims, actions, damages, costs, or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of Chameleon Tattoo and Body Piercing employees, agents, whether a COVID-19 infection occurs before, during, or after participation in any tattoo, piercing work, or any other services provided by Chameleon Tattoo and Body Piercing LLC. I Agree ALL PIERCING CLIENTS MUST SIGN AND RECIEVE A COPY OF THIS FORM, PRIOR TO ANY PIERCING PROCEDURE PIERCING DISCLOUSRE STATEMENT AND CONSENT FORM As with any invasive procedure, piercing may involve possible health risks. These risks may include: - pain, bleeding, swelling;
- scarring, hypertrophic scarring, and keloid formation;
- possible nerve damage;
- febrile (fever) illness;
- tetanus; and
- infection - local or systemic
- The use of unsterile equipment and needles can spread infectious disease; it is extremely important to be sure that all equipment is clean and sanitary before use.
- You may not be allowed to donate blood either temporarily or permanetly
The Piercing Practitioner will: - Properly and thoroughly cleanse the area before the tattooing procedure
- Use sterilized equipment
- Use sterile techniques
- Provide information on the aftercare of the area receiving a piercing, available at https://www.chameleonbodyarts.com/after-care-piercing
HEALTH HISTORY The following conditions may increase health risks associated with receiving a piercing: - diabetes;
- hemophilia (bleeding);
- skin diseases, lesions, or skin sensitivities to soaps, disinfectants etc.;
- history of allergies or adverse reactions to pigments, dyes, or other sensitivities;
- history of epilepsy, seizures, fainting or narcolepsy;
- use of medications such as anticoagulants, (such as coumadin) which thin the blood and/or interfere with blood clotting; and
- hepatitis or HIV infection
RECOMENDED INSTRUCTIONS FOR THE AFTERCARE OF PIERCINGS - Do not ever touch your new piercing - as long as you NEVER touch your piercing while it's healing, you will have no trouble with bacterial infection. Introducing your piercing to foreign bacteria is what causes infection, i.e.: touching money, doorknobs, and/or other people's hands, and THEN touching your piercing. No piercing gets infected on its own.
- Items to buy for after care
- Neilmed piercingaftercare spray or comparable sterile saline wound wash: spray directly onto the piercing and air dry once or twice daily. If your skin becomes dry/ashy and feels itchy and right, just use solution once a day.
- NEVER USE: Bacitracin or Neosporin. Petroleum based ointments CLOG the piercing and make it difficult for your body to heal.
- NEVER USE: Rubbing alcohol, hydrogen peroxide, Claire's ear care solution, betadine, witch hazel, or hibiciens. These products are too strong and will irritate your skin and piercing.
- Some swelling, rednes, and tenderness is normal during the healing process. If you ever experience redness in the area surrounding your piercing for 24 hours or more, PLEASE call to make an appointment to come show it to us right away!
- You should contact your health care provider if you experience any unexpected redness, excessive redness, a rash, greenish discharge, or if you have a fever within 24 hours of the procedure.
- OPTIONAL: sea salt and warm water soaking - soak your piercing three to five times a week in sea salt water for 5-15 minutes. Wash your hands, and place 1/8th of a teaspoon of sea salt in a shot glass or any small glass (8 oz), fill with very warm water, stir, lean forward, place the piercing over the glass, press the glass towards the body, lean back and let it soak.
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CLIENT CONSENT I have read and understand the above information I Agree I do not have a condition that prevents me from recieivng a piercing I Agree I am not under the influence of any drug or alcohol I Agree I am not pregnant and don't suspect that I may be pregnant I Agree I consent to the performace of the piercing procedure and I have been given verbal and written aftercare insturctions as required by the Cambridge Body Art Regulation I Agree I am aware that all information disclosed will be kept confidential I Agree I am aware that a copy of this document will be provided to me I Agree Consult a health care provider for: - unexpected redness, tenderness or swelling at the site of the piercing
- rash
- unexpected drainage at or from the site of the piercing
- fever within 24 hours of the piecring
PROCEDURE FOR FILING A COMPLAINT If there is any sign of injury, infection, conplication or disease as a result of a piercing rocedure, first contact a healthcare provider for medical evaluation. Then notify this establisment and the CAMBRIDGE PUBLIC HEALTH DEPARTMENT, 119 WINDSOR STREET, CAMBRIDGE,MA 02139. Phone: (617) 665-3848 |