Welcome

1

Full Name

First Name

Last Name

2

Phone Number

Please enter a valid phone number.

3

Email

example@example.com

4

Do you have any of the following?

Pacemaker

Allergy/Sensitivity to Metal

Any other condition that would make this permanent jewelry experience unsafe?

None of the above

5

All of my questions regarding permanent jewelry have been answered by BellezaxEvelyn, LLC. to my satisfaction.

YESNO

6

I understand that all jewelry at BellezaxEvelyn is final sale.

YESNO

7

I understand that this jewelry can break and/or stretch if pulled or caught.

YESNO

8

I understand that this permanent jewelry can be easily removed.

YESNO

9

I acknowledge that I do not have a pacemaker, a sensitivity or allergy to any metals, or have any other condition that might make this permanent jewelry experience unsafe.

YESNO

10

If the item breaks or is removed within the 30 day satisfaction guarantee policy, we will reattach items free of charge.

YESNO

11

I understand not to look directly at the "SPARK" during the welding process. Doing so could severely affect my eyesight.

YESNO

12

I am aware that any sudden movement could cause the welder to scratch or burn my skin.

YESNO

13

It is my responsibility to remain still and not look directly at my permanent jewelry while it is being welded.

YESNO

14

By signing this form, I acknowledge and accept that BellezaxEvelyn, LLC. is not liable for any medical condition or injury caused by this experience or jewelry.Do you acknowledge and accept this waiver form? Please sign below.

15

Please date below.

Date