Clone of Spark Project Collective Consent to Pierce and Release of Claims

I acknowledge by signing this release I have been given the full opportunity to ask any and all questions which I might have about obtaining a piercing from Spark Project Collective and all my questions have been answered to my full and total satisfaction. I acknowledge I have been advised of the matters set forth below and I agree as follows:

Body Piercing - The act of creating a hole in a part of the body for the wearing of jewelry.

Full Name*

First NameLast Name

Home Address

Street Address

CityState / Province

Postal / Zip CodeCountry

ID or Drivers License #*

Birth Date*

MonthDayYear

I acknowledge that by submitting this form that I am giving permission to Spark Project Collective to contact me via text message for special promotions. Messages will be sent no more than 3 times monthly.

E-mail

Phone Number*

Area CodePhone Number

I have trustfully represented to the piercer I am over the age of 18 years. I am NOT under the influence of drugs or alcohol. To my knowledge, I DO NOT have any physical, mental, or medical impairment or disability which might affect my well-being as a direct or indirect result of my decision to have a piercing done at this time. I acknowledge that the service that is about to be provided to me is non-refundable for any reason. I will be shown my marking for piercing prior to my piercing for the personal consent of where it will be going. My first marking will be the one suggested by my piercer and their professional opinion. Any further markings will be made in accordance to my wishes and therefore will not hold my piercer responsible for the placement or the misplacement of my piercing in any way.*

Agree

I am NOT pregnant or nursing. I do NOT have epilepsy or hemophilia. I do not suffer from any heart conditions or take medication which thins the blood. I have informed my piercer of any condition such as diabetes that might hamper the healing of the piercing. If I suffer from hepatitis, or any other communicable disease, I have informed the piercer of this fact and I have been advised of any procedures necessary to promote the satisfactory healing of my piercing. i DO NOT have any form of herpes infection at the proposed procedure site.*

Agree

I have advised the piercer of any allergies to metals, latex gloves, soaps and medications. I acknowledge it is not reasonably possible for the piercer to determine whether I might have an allergic reaction to the piercing or processes involved in the piercing and further acknowledge that such a reaction is possible. I DO NOT have cardiac valve disease and am NOT on any antibiotics. If I am I have informed my piercer and they have made a note of my medications. I acknowledge that obtaining this piercing is my choice alone and will result in a permanent change to my appearance, and that no representation has been made to me as to the ability to later restore the skin inbolbed in this piercing to its pre-piercing condition.*

Agree

I understand I will be pierced using appropriate instruments and sterilization. Therefore, I request Spark Project Collective to proceed with my piercing and I understand that my piercing usually takes at least 6 weeks or longer to heal. I agree to release and forever discharge and hold harmless the piercer and Spark Project Collective as a whole from any and all claims, damages or legal actions arising from or connected in any way with my piercing, or the procedure and conduct used before, during and after my piercing. I acknowledge that Spark Project Collective reserves the right to record the buildings 24 hours per day inside all rooms, public areas and its surrounding parking lot to protect the staff and possible loss of any equipment and property.*

Agree

Signature*