"Link" Permanent Jewelry Consent Form

"Link" Permanent Jewelry Consent Form

This consent form is intended for the client. If the client is under 18 years old, a parent/legal guardian will fill out the very last section. This form covers consent for "Link", our permanent jewelry service. If you have any questions/concerns about a question on this form, just ask our counter staff. Thank you!
Location of Permanent Jewelry*
Please select your Service Provider *
Full Name*

First NameLast Name
Name you go by if different than above
Pronouns*
Date of Birth*

YearMonthDay
Age*
Email*
example@example.com
Would you like to be added to our email newsletter?*
Phone Number*
Please enter a valid phone number.
Illness Symptoms: I confirm that I am not presenting any cold or flu-like symptoms including: dry cough, runny nose, sore throat, shortness of breath, loss of sense of taste or smell, fever - temperature: 100 degrees or above*

I confirm
Duress: I affirm that I am not under the influence of alcohol or drugs, and I am voluntarily getting a piercing without duress*

I affirm
Care: I will not tug or yank on my permanent jewelry as this could stretch or break the chain. I won't roll the chain up to to parts of the body that cause it strain. I will be mindful when changing my clothing as not to break the chain. I understand that I can use a mild soap and water solution to clean your bracelet or I can also use a jewelry polishing cloth to help remove dirt and grime.*

I acknowledge
Permanence: I acknowledge that this chain will be welded, there will be no clasp to take it off. If I need to take it off, I will need to make an appointment to have it removed for a removal fee*

I acknowledge
Risks: I acknowledge that I have been fully informed of the risks associated with getting permanent jewelry. I understand that these risks, known and unknown, can lead to injury including but not limited to tissue or eye damage. Though it is unlikely, that the voltage will be high enough to create such a spark that injury can occur to the skin upon weld, it is a risk. The spark that occurs at the moment of welding can cause injury to the eye, I acknowledge that I should not look directly at the spark. I may decide to look away, wear protective lenses provided to me by the practitioner, or I can look through the screen of my cell phone. All of these methods will keep my eye protected. I understand that this jewelry can cause injury if snagged and does not break. Having been informed of the potential risks associated with permanent jewelry, I still wish to proceed and I freely accept all risks that may arise from having a chain welded around part of my body.*

I acknowledge
Acknowledgment of Jewelry Policy: I acknowledge that the jewelry I am purchasing can not be returned or refunded. In the case that the jewelry is lost, Mom's Custom Tattoo & Body Piercing or their service providers are not liable and the lost jewelry will not be replaced. If the chain breaks and is in need of repair, I can bring in the chain and the service provider will fix it for me at no additional charge within two weeks. After two weeks, I will have to pay a welding fee.*

I acknowledge
Adjustment Agreement: If I decide that I want to shorten my chain length after initial weld, the service provider will wave the welding fee for one adjustment within 2 weeks of initial weld, after 2 weeks, the adjustment will be subject to welding fee.*

I acknowledge
Release: TO WAIVE AND RELEASE to the fullest extent permitted by law each of the service providers and Mom's Custom Tattoo & Body Piercing from all liability whatsoever, for 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 and/or consequential damages, which result or arise, whether caused by the negligence or fault of the service provider, or otherwise*

I agree
Attorney Fees: I agree to reimburse each of the Artist and Mom's Custom Tattoo & Body Piercing for any attorneys, fees, and costs incurred in any legal action I bring against either the Artist or Mom's Custom Tattoo & Body Piercing and in which either the Artist or Mom's Custom Tattoo & Body Piercing is the prevailing party. I agree that the courts of Spokane in Washington, USA shall have personal jurisdiction and venue over me and shall have exclusive jurisdiction for the purpose of litigating any dispute arising out of or related to this agreement*

I agree
Photography: I release all rights to any photographs taken of me and the permanent jewelry and give consent in advance to their reproduction in print or electronic form. (If you do not select yes on this provision, please advise and remind your service provider and NOT to take any pictures of you and your completed permanent jewelry!)*
Follow Up: Do you consent to follow up contact to check on how your chain is doing? Default contact mode is email, inform your service provider if you would prefer a different method*
Deposits: Deposits will apply to my appointment for my service. They are nonreturnable and nonrefundable. During payment, the deposit will be applied first and whatever payment method you prefer can be used after that (this includes cash, card, or gift card).*

I understand
Pricing: I know the cost of my procedure/jewelry and have enough money to cover the full amount including tax. I will pay after the procedure, and understand that once the jewelry is on me, it's mine. I also understand that there are no refunds or returns on my jewelry.*

I agree
Metallic Abrasion is a risk: Metallic abrasion is when tiny metal particles rub off jewelry and onto skin or fabric, leaving a smudge that can be black, greenish, or grayish. This is an occurrence that can happen. It's how some body chemistries react with the chain, and it does not happen to everyone. If this occurs, wash your skin to scrub it off and it might not return though we can not guarantee this. It should be scrubbed off in the shower. The most common cause of metallic abrasion is makeup and other personal care products, such as lotions, creams, oils, and perfumes. These products often contain compounds that are harder than the jewelry's gold alloy, and when they rub against the jewelry, they wear away or rub off tiny metal particles. The particles appear as a fine black dust or powder, and when they come into contact with absorbent surfaces like skin, they stick and create a smudge.*

I acknowledge
Questions: I acknowledge that both the service provider and Mom's Custom Tattoo & Body Piercing have given me the full opportunity to ask any and all questions about the procedure and the they have been answered to my total satisfaction*

I acknowledge
I understand I may request my service provider to wear a mask for the duration of my appointment.*

I understand
I understand my service provider may request that I wear a mask during my appointment.*

I understand
This Document: I acknowledge that I have been given adequate opportunity to read and understand this document, that it was not presented to me at the last minute, and I understand that I am signing a legal contract*

I acknowledge
Signature*

Clear
If the client is under 18 years of age, please have a parent/guardian fill out the section below
We can not take a photo of Military ID, please type in your military ID number below.
Parent/Guardian Name

First NameLast Name
Relation to client

Birth ParentAdoptive ParentLegal GuardianParent By MarriageOther
Parent/Guardian Date of Birth

MonthDayYear
Parent/Guardian Phone Number if different than at the top of the form
Please enter a valid phone number.
Parent/Guardian Email if different than at the top of the form
example@example.com
Parent/Guardian Signature

Clear
Thank You!

We recognize that you have a choice to make when it comes to your body modification needs and we appreciate that you have chosen us for your piercing today. If any provision, section, subsection, clause or phrase of this release is found to be unenforceable or invalid, that portion shall be severed from this contract. The remainder of this contract will then be construed as though the unenforceable portion had never been contained in this document.
Once this page re-directs, please don't fill out any other form unless explicitly told to do so by your service provider or our counter staff. Any form filled out without instruction to do so will be voided.
Should be Empty:

"Link" Permanent Jewelry Consent Form

If the client is under 18 years of age, please have a parent/guardian fill out the section below

Thank You!

Once this page re-directs, please don't fill out any other form unless explicitly told to do so by your service provider or our counter staff. Any form filled out without instruction to do so will be voided.