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RELEASE AND WAIVER OF LIABILITY

Permanent jewelry is a process that involves the use of welding the jewelry together while on your body. The procedure is generally painless and is performed with your safety in mind. This consent form is intended to inform you of the risks of the procedure and to obtain your informed consent for the procedure. 

PLEASE INITIAL EACH STATEMENT:

 I understand that although rare, an allergic reaction to the jewelry can occur.


I understand that the welding procedure does have some risks; including but not limited to potential allergic reactions, irritation, discomfort, burns, and scarring.


I understand that although this jewelry is intended to be permanent, durable and long-lasting, the length of wear can vary depending on my physical activity and other factors. I understand that all sales are final.


I understand that there may be some instances where i will be required to remove my jewelry, including but not limited to medical procedures like MRI and surgery. I understand that the jewelry can easily be removed with scissors and re-attached by the jeweler at a later date.



I give the technician/jeweler permission to photograph my jewelry and procedure for their own marketing and promotional purposes.


 

ACKNOWLEDGEMENT:

I completed the above form to the best of my knowledge. I have had the opportunity to ask my questions and have received satisfactory answers. I understand the risks and potential side effects associated with the permanent jewelry procedure. I understand that the results of the procedure are not guaranteed and may vary from person to person. I am over the age of 18 and consent to the procedure. If I am under the age of 18, a parent or guardian must sign. I will not hold the technician/jeweler, salon, or employees liable for any issues not disclosed at the time of my service or any adverse effects from the permanent jewelry procedure. This agreement remains in effect for this procedure and any follow-up appointments.


Today's Date: October 18, 2024

First Client's Name

First Name*

Last Name*
First Client's Age Acknowledgment*
First Client's Date of Birth*
I certify that I am 18 years of age or older
First Client's Signature*
Second Client's Name

First Name*

Last Name*
Second Client's Date of Birth*
Third Client's Name

First Name*

Last Name*
Third Client's Date of Birth*
Fourth Client's Name

First Name*

Last Name*
Fourth Client's Date of Birth*
Fifth Client's Name

First Name*

Last Name*
Fifth Client's Date of Birth*
Sixth Client's Name

First Name*

Last Name*
Sixth Client's Date of Birth*
Seventh Client's Name

First Name*

Last Name*
Seventh Client's Date of Birth*
Eighth Client's Name

First Name*

Last Name*
Eighth Client's Date of Birth*
Ninth Client's Name

First Name*

Last Name*
Ninth Client's Date of Birth*
Tenth Client's Name

First Name*

Last Name*
Tenth Client's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.

I am the parent or legal guardian of the minor named below. I have the legal right to consent to and, by signing below, I hereby do consent to the terms and conditions of this Release and Waiver of Liability.



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*

Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Signature*
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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