Permanent Jewelry Consent and Waiver Form

Permanent Jewelry Consent and Waiver Form

Please read the terms and conditions carefully before providing your consent. Your agreement is necessary to proceed.
Full Name

First NameLast Name
Email Address
example@example.com
Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date of Consent

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Terms and Conditions Agreement
Legal Disclaimer and Additional Comments
Thank you for selecting our jewelry shop for your permanent jewelry creation. To ensure you receive the best service and prioritize your safety, we kindly ask you to complete this Intake and Consent Form.

Please read this document thoroughly and sign it to confirm your understanding and agreement with the terms and conditions outlined below.

I willingly choose to proceed with this appointment after The Sparkling Sparrow has explained the nature and purpose, along with the associated risks and hazards.

By signing this form, I acknowledge the inherent risks involved in welding permanent jewelry. These risks may include, but are not limited to, burns, discomfort, allergic reactions, and potential scarring, all of which I accept.

I agree to provide accurate and comprehensive information regarding my health history, including any medical conditions, allergies, or medications that may affect my ability to undergo the welding process.

By signing this document, I release The Sparkling Sparrow and its employees from any liability for harm, discomfort, or injury that may arise during the welding process. I also understand that any injury or harm resulting from the welding process is my sole responsibility.

I confirm that I have received and understood the aftercare instructions for the permanent jewelry and agree to follow them as directed.
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