Tooth Gem Consent Form

1. I, certify that this Informed consent, and waiver form was completed by me and that I understand all the questions, terms and conditions, and all entries in it and information are true and complete to the best of my knowledge. I agree to observe and obey all posted, written and oral rules and warnings, including on those materials provided by Organic Oasis Spa.

2.  I agree to waive and release to the fullest extent permitted by applicable law each of the Tooth Gem service provider and the management of Organic Oasis Spa from all liability whatsoever, from any and all claims or causes of action that I, my estate, heirs, executors or assigns may have for personal injury or otherwise, including any direct or consequential damages, which may result or arise from the application of, or my accidental swallowing of tooth gems, weather caused by the negligence or fault of the Tooth Gem service provider.

3. I am 16 years old or over.

4. I understand that the application of tooth gems and products does not include any drilling into the tooth or breaking skin and may cause marks or discoloration of my teeth.

5. I understand that the application process of tooth gems may affect my tooth enamel, and I have been given the opportunity to talk about the risks associated with my Tooth Gem products with my Tooth Gem service provider.

6. I understand that the bonding agent used to apply my tooth gem may affect my teeth, and that I have been given the opportunity to talk about the risks associated with the bonding agent with my Tooth Gem service provider.

7. I understand and agree that the tooth gem application procedure is semi-permanent and there is no guaranteed amount of time the products will remain on my tooth.

8. I understand that certain tooth gems may fall off for any or no reason after applying the gems to my teeth. I understand and agree that Organic Oasis Spa is not responsible for replacing or substituting any products, including any gems, white gold, crystal or gold charms, if my tooth gem falls off.

9. I understand that I should continue to see a dentist regularly to maintain proper oral health and hygiene for my teeth.

10. I have been advised that I should contact a dentist to remove all residue from the bonding agent from my tooth if my tooth gem falls off or if I wish to remove it.

11. I understand and will follow the aftercare instructions given to me by the Tooth Gem service provider to ensure the longevity of my tooth gem.

12. I hereby authorize my Tooth Gem service provider and Organic Oasis Spa permission to take photographs and use my likeness in a photograph or video for its promotional materials and publications, print and digital. I understand and agree that all rights to any photograph of me belong to Organic Oasis Spa. If you do not authorize permission to take and use your photos, you must speak to service provider before application of service.

I HAVE READ THIS DOCUMENT AND UNDERSTAND ITS CONTENTS. I FURTHER UNDERSTAND THAT BY SIGNING THIS RELEASE OF LIABILITY, I VOLUNTARILY SURRENDER CERTAIN RIGHTS. ORGANIC OASIS  SPA IS NOT RESPONSIBLE FOR ANY DAMAGE CAUSED BY THE TOOTH GEM APPLICATION.