Jewelry Assessment/Removal/Stretch Release Form

Chameleon Tattoo and Body Piercing

36 JFK Street

Cambridge, MA

02138

Waiver of Liabilty Relating to 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.

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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

Type Initials

Draw Initials

Initial

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Release Form

For Piercing Assement, Stretching, Insertion or Removal

By signing this form, I induce Chameleon Tattoo and Body Piercing to stretch or assess my piercing, or to insert or remove jewelry into/from my previous piercing,and in consideration of doing so, I herby release Chameleon Tattoo and Body Piercing and it's employees and agents, from all manner of liabilities, claims, actions and demands, in law or equity, which I or my heirs have or might have no or hereafter by reason of complying with my request to have my piercing accessed, stretched, or to have my jewellery instered/removed. Aftercare available https://www.chameleonbodyarts.com/after-care-piercing

My signature below, I give promising for said insertion/removal/assessment and I further understand that if I give false information or produce false documents stating my name and age to be other than correct, then I am liable for prosecution.

I Agree

Type Initials

Draw Initials

Initial

Please select who will be participating...

Adult Minor

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First Client's Name

First Name*

Last Name*

Phone*

First Client's Date of Birth*

First Client's Information

What service are you requesting*

Please select the piercer you are working with*

Preferred pronouns of client*

First Client's Signature*

Type Signature

Draw Signature

Click to Sign

Parent or Guardian's Email Address

Email*

Confirm Email*

Parent or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*

Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.

By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.

Parent or Guardian's Name

First Name*

Last Name*

Relationship*

Phone*

Parent or Guardian's Date of Birth*

Parent or Guardian's Information

What service are you requesting*

Please select the piercer you are working with*

Preferred pronouns of client*

Parent or Guardian's Signature*

Type Signature

Draw Signature

Click to Sign

Electronic Signature Consent*

By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.

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Agree To This Document