Scarification/Branding

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Let us do this part

Today's Date:

Mon Apr 29 2024 07:54

Practitioner:*

Design Description:*

Please read and answer

Artists Rights*

The Artist has the right to refuse any client and any design. If the client is rude, disrespectful, or abusive, the appointment will be canceled and the deposit will be VOID. If the design is racist, hateful, or gang-related, the artist has the right to refuse the design. If the client is rude, disrespectful, or abusive, they may be banned from receiving any services, from any artist at The Studio, at any future time.

Do you have Flu like symptoms?*

DO YOU HAVE:

- cough
- fever or chills
- flu-like symptoms
- difficulty breathing or shortness of breath
- recent exposure to COVID-19
- sore throat, trouble swallowing
- runny nose / stuffy or nasal congestion
- decrease or loss of smell or taste
- nausea, vomiting, diarrhea, abdominal pain

How did you hear about us?

Eaten*

Have you eaten in the past 4hrs? It's a good idea to before hand to increase your blood sugar levels.

Bloodbourne Pathogens*

Do you have any bloodborne pathogens, transmittable diseases, or recent illnesses? (It's okay if you do, we just want to know for our and others' safety).

Details:

Risks*

That I have been fully informed of the risks, associated with getting a scarification/branding. I understand that these risks, known and unknown, can lead to injury, including but not limited to infection, scarring, keloids, uneven scarring, and allergic reactions. Having been informed of the potential risks associated with getting a scarification/branding, I still wish to proceed with the piercing and I freely accept all risks that may arise from scarification/branding.

Release*

TO WAIVE AND RELEASE to the fullest extent permitted by law each of the Artist and the Piercing Studio from all liability whatsoever, for any and all claims or causes of action that I, my estate, heirs, executors, or assigns may have for personal injury or otherwise, including any direct and/or consequential damages, which result or arise, whether caused by the negligence or fault of either The Artist or The Studio or otherwise.

Questions*

That both The Artist and The Studio have given me the full opportunity to ask any and all questions about the piercing procedure and they have been answered to my total satisfaction.

Aftercare*

I affirm that The Artist has given me instructions on the care of my scarification/branding while it's healing, and I understand them and will follow them. I acknowledge that it is possible that the scarification/branding can become infected, particularly if I do not follow the instructions. I will not submerge or soak my scarification/branding in any body of water such as, but not limited to pools, lakes, oceans, rivers, hot tubs, baths, or saunas while it is healing and my skin is not yet fully healed closed.

Duress*

I affirm that I am not under the influence of alcohol or drugs, and I am voluntarily getting a scarification/branding without duress.

Medical Conditions*

I affirm that I do not have diabetes, epilepsy, hemophilia, nor do I have a heart condition or take blood thinning medication. I do not have any other medical or skin condition that may interfere with the procedure or healing of the piercing. I am not the recipient of an organ or bone marrow transplant or, if I am, I have taken the prescribed preventive regimen of anti-biotics that is required by my doctor in advance of any invasive procedure such as piercing. I am not pregnant or nursing.

Details:

Permanent change*

I acknowledge that the scarification/branding will result in a permanent change to my appearance and that my skin may not be restored to its pre-modified condition even after dermatological treatments. I understand that not all people's scars/brands heal in the same tone, colour, texture, size, and consistency. I understand that my skin may heal to be flat, indented, or raised. I understand that scars/brands will change colour over time as they mature.

This Document*

I acknowledge that I have been given adequate opportunity to read and understand this document, that it was not presented to me at the last minute, and I understand that I am signing a legal contract.

Attorney Fees*

I agree to reimburse each of The Artist and The Studio for any attorneys. fees and costs incurred in any legal action I bring against either The Artist or The Studio and in which either The Artist or The Studio is the prevailing party. I agree that the that the courts of Ontario in Canada shall have personal jurisdiction and venue over me and shall have exclusive jurisdiction for the purpose of litigating any dispute arising out of or related to this agreement.

Photography*

I release all rights to any photographs taken of me and the piercing and give consent in advance to their reproduction in print or electronic form.

If any provision, section, subsection, clause or phrase of this release is found to be unenforceable or invalid, that portion shall be severed from this contract. The remainder of this contract will then be construed as though the unenforceable portion had never been contained in this document.

Client Information

I hereby declare that I am of legal age (with valid proof of age) and am competent to sign this Agreement.

Legal Name:*

Pronoun:

Chosen name:

Address:*

Date of birth:*

You must be 18 or older

Phone #:*

Email:*

Signature:*

Sign above or type signature:

Photo ID*

Please take photo(s) of your government issued photo IDs and related paperwork.