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Skye Body Piercing Release Form

Let us do this part

Today's Date:

Fri Mar 24 2023 12:56

Practitioner:*

Body Piercing Location:

Special Circumstances / Considerations:

Body Piercing Release Form

Please read and answer

Symptomatic Allergies or Signs of Sickness*

Do you agree that symptoms of illness or severe allergies will require rescheduling of your appointment? Due to health concerns, concerns for our clients, the shop environment and artists, all allergy symptoms or symptoms of being sick ie: coughing, sneezing, runny nose, sore throat etc will require the appointment to be rescheduled or stopped. Even with just having allergy symptoms this still applies because coughing and sneezing can still transmit an asymptomatic Covid-19 infection. This applies for the artist as well and may require your artists to reschedule.

Age*

I am 18 years of age or older or have parental consent for this piercing.

Eaten*

I have eaten sufficiently in the last 4 hours. It is important to be nourished before putting the body through stress.

Duress*

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

Y

N

Medication*

Are you taking any prescribed or over the counter medication?

Details:

Y

N

Medical Conditions*

I affirm that if I have diabetes, epilepsy, hemophilia, heart condition, take blood thinning medications or have any ailments that could effect this procedure or healing that I will let my piercer know. 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 antibiotics that is required by my doctor in advance of any invasive procedure such as piercing. I am not pregnant or nursing.

Details:

Y

N

Bloodbourne Pathogens*

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

Details:

Jewelry and Procedure*

I understand that the piercer or ISTARI LLC DBA SKYE TATTOO cannot be held responsible if my body reacts negatively to the metal of the jewelry.

I also understand that sterilized jewelry and equipment and / or single use disposables will be used for my piercing.

Risks*

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

Release*

TO WAIVE AND RELEASE to the fullest extent permitted by law each of the Piercer and ISTARI LLC DBA SKYE TATTOO 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 Piercer or ISTARI LLC DBA SKYE TATTOO, or otherwise.

Questions*

That both the Piercer and ISTARI LLC DBA SKYE TATTOO have given me the full opportunity to ask any and all questions about the piercing procedure and the they have been answered to my total satisfaction.

Aftercare*

I affirm that I have been given instructions on the aftercare of my piercing. I understand these instructions and will follow them. I acknowledge that it is possible that the piercing can become infected, particularly if I do not follow the instructions. I understand the Piercer's suggestions are not to be confused with medical advice.

Permanent change*

I acknowledge that the piercing will result in a permanent change to my appearance. My skin may not be restored to its pre-piercing condition even after its removal.

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 Piercer and ISTARI LLC DBA SKYE TATTOO for any attorneys. fees and costs incurred in any legal action I bring against either the Artist or the Piercing Studio and in which either the Artist or the Piercing Studio is the prevailing party. I release Skye Tattoo and it’s agents from liability with regards to any circumstances beyond their control.

Photography*

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

Global Pandemic*

I agree that there is a current Global Pandemic; Covid-19, AKA 2019 novel coronavirus, 2019-nCoV, SARS-CoV-2 declared by World Health Organization. Covid-19 is extremely contagious. The virus that causes COVID-19 is believed to spread via droplets via respiratory, Aerosolized transmission via living in the air up to 3 hours, Surface transmission via several days. Spread is more likely to occur during close contact with an infected person symptomatic or asymptomatic.

Full and Voluntary Assumption of Risk*

ISTARI LLC DBA SKYE TATTOO has engaged and is enforcing preventive measures that follow the CDC and States guidelines to reduce the spread of Covid-19. These preventive measures however are not guaranteed as Covid-19 infection can happen to anyone anywhere. Being inside any business and partaking in services could increase your risk of infection.

I am voluntarily making assumption of risk and that I may be exposed to or infected by entering ISTARI LLC DBA SKYE TATTOO. That may result in personal injury, illness, permanent disability and death. I understand that the risk of becoming exposed to or infected by Covid-19 at ISTARI LLC DBA SKYE TATTOO may result from these actions, omissions, or negligence of myself and others including but not limited to ISTARI LLC DBA SKYE TATTOO's employees, contractors and / or representatives.

Y

N

Recent Exposure of Covid-19*

Have you or any family member of your household tested positive, or been exposed to someone who has tested positive, for a viral infection ie: Covid-19 in the last 14 days?

Y

N

Recent Symptoms of Illness*

Have you or any member of your household experienced symptoms of a viral infection? Any of the following: Fever, loss of taste or smell, dry cough, running nose, sore throat, or shortness of breath in the past 14 days?

Prolonged Physical Contact*

I understand that the services ISTARI LLC DBA SKYE TATTOO offers, require prolonged physical contact and are administered within the otherwise recommended six feet of distance.

Jewelry Switch-outs *

I understand that I may need longer or larger jewelry inserted initially to account for swelling. I may need a smaller size or a piece of jewelry with a shorter post inserted after my piercing has healed for a healthier and more comfortable fit. This piece of jewelry will still be charged for as well as an insertion fee.

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.

Personal Info

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:*

Postcode:

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.