La Di Da Permanent Jewelry Consent Form

Permanent Jewelry Consent Form

Release and Waiver of Liability
Date Signed*

MonthDayYear
Name (Please list name of person receiving permanent jewelry.)*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Date of Birth*

MonthDayYear
Date
Do you have any of the following?*

PacemakerAllergy/sensitivity to metalAny other condition that would make this permanent jewelry experience unsafe?None of the above
Release and Waiver of Liability

All of my questions regarding permanent jewelry have been answered by La Di Da ATX, LLC to my satisfaction. I understand that all La Di Da ATX, LLC jewelry is final sale. I understand that this jewelry can break and/or stretch if pulled or caught. I understand that this permanent jewelry can easily be removed. I understand how to take proper care of my permanent jewelry. I understand that if anything happens to my jewelry within the first two weeks, La Di Da ATX, LLC will offer to fix or replace it complimentary at their next pop-up or in-studio. I understand that La Di Da ATX, LLC guarantees the weld but not the chain or jewelry itself. 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. By signing this form, I acknowledge and accept that La Di Da ATX, LLC is not liable for any medical condition or injury caused by this experience or jewelry. I grant La Di Da ATX, LLC permission to capture images and likeness in photographs, videotapes, and/or digital media. A parent/guardian signature is required if under the age of 18.
Yes, I agree and acknowledge the release and waiver of liability.
Full name of person receiving permanent jewelry if over the age of 18 OR Parent/Guardian full name if under 18. *

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