PERMANENT JEWLERY WAIVER
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Acknowledgement & Consent I understand that by receiving a Permanent Jewelry service, a piece of jewelry will be welded closed on my body without the use of a clasp. I have been informed of the process and possible risks.
Voluntary Procedure: I am choosing to receive this service voluntarily and the process has been explained to me.
Possible Risks: I understand welding involves a small spark and carries minimal risks such as minor burns, allergic reactions, or irritation. I will inform my technician of any metal allergies or sensitivities.
Aftercare: I am responsible for jewelry care after application. Repairs/replacements may incur a fee.
Medical Disclosure: I confirm I do not have conditions that may interfere with this service (including metal allergies, skin sensitivities, or recent surgeries near the placement area).
Removal: Permanent jewelry can be removed by cutting the welded jump ring with scissors or wire cutters. The technician is not responsible for removal after the appointment.
Liability Release: I release the jewelry artist and Jade by BCV from liability related to loss, injury, or damage that may occur as a result of this service.
Signature
Allergies & Notes Do you have any metal allergies or skin sensitivities?
YES
NO
If yes, please describe:
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Photo Consent (optional)
I consent to photos/videos being taken for marketing or social media.
I do not consent to photos/videos being taken.
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I certify that my typed name constitutes my electronic signature and that I have read and agree to all terms above.
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Signature
Submit
Submit
Should be Empty: