Permanent Jewelry Waiver, Release and Consent Form

Parental Consent Waiver and Release Form for Permanent Jewelry

Please fill out this form to provide consent for the minor child to participate in the permanent jewelry process while acknowledging the risks and releasing the jewelry provider from liability.
Parental / Guardian Information
Full Name of Parent / Guardian

First NameLast Name
Relationship to Minor
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Minor's Information
Full Name of Minor

First NameLast Name
Age of Minor
Date of Birth

MonthDayYear
Date
Introduction

This form must be completed by the parent or legal guardian of any minor (under 18 years old) who wishes to receive permanent jewelry. By signing this form, the parent/guardian provides consent for the minor to participate in the permanent jewelry procedure and acknowledges the risks involved, releasing the jewelry provider, event organizers, and associated personnel from any liability.

Please read and complete all sections before signing:

Understanding of Risks and Procedure

I, the undersigned parent/legal guardian, acknowledge that I have been informed of the permanent jewelry procedure and its associated risks, which may include but are not limited to:
- Burns from the welding tool
- Allergic reactions to metals, adhesives, or other materials
- Skin irritation, infection or injury from the procedure
- Accidental injury during the process
- Long-term care and maintenance requirements for the jewelry
I understand, accept these risks and give my consent for the minor to proceed with the permanent jewelry procedure.
Liability Release

In consideration of the minor being allowed to receive the permanent jewelry service, I hereby release, discharge, and hold harmless the jewelry provider, event organizers, and all associated personnel from any and all claims, liabilities, or causes of action, including but not limited to:
- Injuries arising from the use of welding tools or jewelry materials
- Allergic reactions or skin conditions
- Accidents, infections, or injuries resulting from the procedure
- Any loss, damage, or injury to the minor during or after the event
I agree to hold harmless and indemnify the event organizers and jewelry provider from any legal claims, damages, or costs associated with the minor's participation.
I understand that the jewelry provider and event organizers are not liable for any medical costs, damages, or claims arising from the minor's participation.
Medical Information

I affirm that I have disclosed any relevant medical conditions, allergies, or skin sensitivities that may affect the minor's participation in the permanent jewelry procedure, including but not limited to:
- Allergies to metals (e.g., nickel, gold, silver)
- Skin conditions (e.g., eczema, psoriasis, rashes)
- Any other health concerns that may impact participation
Consent for Permanent Jewelry

I understand that permanent jewelry involves welding or attaching jewelry to the minor’s body, and the jewelry is intended to remain in place until removed or altered. I consent to the application of permanent jewelry on the minor and acknowledge that it is my responsibility to ensure proper aftercare as instructed by the jewelry provider.
I acknowledge that I am fully aware of this and give my consent for the jewelry to be applied during the event.
Photography and Media Release

I consent to photographs, videos, or other media being taken of the minor during the event. These images may be used for promotional, marketing, or social media purposes by the jewelry provider and event organizers. I waive any right to compensation or royalties for the use of such images.
I give permission for photographs or images of the procedure and the jewelry placement to be taken for documentation and educational purposes.
Returns

Please note that all purchases of our permanent jewelry are final. We do not offer refunds or exchanges under any circumstances.

It is the minor's responsibility to care for the jewelry, and I accept any and all fault for any damage that may occur.

I understand that every piece of jewelry is custom fit and personalized to each guest, therefore, all purchases are final sale and no refunds or replacements are offered under any circumstance. NO REFUNDS will be given for lost, stolen, damaged or snagged pieces.
Do you understand the terms and conditions listed above?
GOVERNING LAW: This agreement shall be governed by and construed in accordance with the laws of FLORIDA STATE/USA, without regard to it's conflict of law principles.
Do you understand the terms and conditions listed above?
Voluntary Participation

I understand that participation in the permanent jewelry procedure is entirely voluntary. The minor is free to decide not to participate at any time during the procedure without penalty or obligation. If the minor chooses not to proceed with the service, I will not hold the jewelry provider or event organizers liable.

Acknowledgment and Agreement

By signing this form, I confirm that I am the parent or legal guardian of the minor named above. I acknowledge that I have read and fully understand the contents of this Waiver and Release Form, including the risks involved in receiving permanent jewelry. I give my informed consent for the minor to participate in the permanent jewelry procedure and agree to the terms outlined in this form.

Signature:

I have read and understood this Parental Consent Waiver Form, and I sign it of my own free will.
Parent / Guardian Full Name

First NameLast Name
Signature of Parent / Guardian:
Date

MonthDayYear
Date
Should be Empty:

Parental Consent Waiver and Release Form for Permanent Jewelry

Parental / Guardian Information

Minor's Information