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Permanent Jewelry

Let us do this part
Today's Date:
Mon Apr 29 2024 11:15
Dead Rockstar Permanent Jewelry Consent Form
Please read and answer
Y
N
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Do you have a pacemaker?
Y
N
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Do you have any metal allergies and/or sensitivities?
Details:
 
Y
N
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Do you have any health conditions that would make this experience unsafe?
Details:
 
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I understand that I must hold very still when it is time to do the actual weld and that there is the possibility of a spark and/or heat. I will also be required to wear safety glasses.
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I understand that jewelry can break and/or stretch if pulled or caught and that over time it may gradually stretch due to the nature of the material. I also understand that if I chose plated jewelry that it may discolor, fade, or rust if exposed to chemicals or salt water.
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I understand that my jewelry will be inspected to make sure it is properly welded before I leave my appointment. If my jewelry breaks AT THE WELD spot within 48 hours then we will re-weld at no charge.
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We cannot offer replacements, refunds, or discounts to replace chains due to the personal nature of the wearer's lifestyle and other external factors that are beyond our control. We do not buyback jewelry and all sales are final.
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I am aware and understand that permanent jewelry requires the procedure of welding jewelry and is a potentially dangerous activity. I acknowledge these risks and acknowledge that I am voluntarily participating in obtaining permanent jewelry and accept and assume all of the risks including possible reactions to the metals contained in the jewelry.
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I hereby consent to receive medical treatment if deemed necessary if I am injured or require medical attention during my participation of the procedure. I understand and agree that I am solely responsible for any and all costs incurred for said medical treatment.
Y
N
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I release all rights to any photographs taken of me and/or my permanent jewelry and give consent in advance to their reproduction in print or electronic form. IF YOU CHECK NO-PLEASE LET US KNOW.
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I hereby waive and release any and all claims, now known or hereafter known, against Dead Rockstar and it's owners, employees, or agents.
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 or, if not, that my parent or legal guardian shall sign on my behalf, and that my parent or legal guardian is in complete understanding and concurrence with this agreement.
Legal Name:*
Pronoun:
Chosen name:
Address:*
Postcode:*
Date of birth:*
If you are under 18 your parent/guardian will be required
Phone #:*
Email:*
Signature:*