Tattoo Galaxy Piercing Release Form

Let us do this part
Today's Date:
Sun Nov 29 2020 10:30
Practioner:*
THIS IS NOT WHERE YOU BOOK AN APPOINTMENT!!! This must completed in addition to booking an appointment at piercerjay.com
Please read and answer
 
Appointment*
What is the date and time for your appointment?
 

 
Procedure*
Is your appointment for a jewelry change or piercing? What piercing is it for?
 

Y
N
Allergies*
Do you have any allergies?
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:
 

Duress*
I affirm that I will not be under the influence of alcohol or drugs for my appointment, and I am voluntarily getting a piercing without duress.
COVID-19*
I acknowledge that Tattoo Galaxy has put in place preventative measures to reduce the spread of COVID-19. However, as a public facility, Tattoo Galaxy cannot guarantee zero risk of infection to those who enter.
COVID-19*
To prevent the spread of contagious viruses and to help protect others, I understand that I must follow Tattoo Galaxy's guidelines and policies. These policies can be changed at any time as new information becomes available.
COVID-19*
I confirm that, in the last 14 days, I have not presented, nor been in contact with anyone presenting any symptoms of COVID-19 including dry cough, fever, shortness of breath, sore throat, nausea, or vomiting.
Y
N
Medical Conditions*
Do you have diabetes, epilepsy, hemophilia, a heart condition, or take blood thinning medication? Do you have any other medical or skin condition that may interfere with the procedure or healing of the piercing? Are you pregnant or nursing? If yes, please describe below.
Details:
 

Risks*
I understand that there are risks associated with getting a piercing, known and unknown, that can lead to injury, including but not limited to infection, scarring, keloiding, and allergic reactions. I still wish to proceed with the piercing and I freely accept all risks that may arise from getting a piercing.
Release*
I agree TO WAIVE AND RELEASE, to the fullest extent permitted by law, Jay McColm and Tattoo Galaxy 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 Piercing Studio, or otherwise.
Attorney Fees*
I agree to reimburse each of the Artist and the Piercing Studio 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.
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.
Policies*
I acknowledge the following policies for Tattoo Galaxy:

-We will be operating on an appointment only schedule and the front door will be locked. No walk-ins will be accommodated. Appointments must be booked at least 1 hour in advance.
-When you arrive for your appointment please wait in your car. We will call you and greet you at the door when we are ready.
-A release form including your government issued photo ID must be completed 1 hour prior to your appointment. The same ID must be brought with you on the day of your appointment. This is for any piercing services, including jewelry changes. If the release form has not been submitted 1 hour prior to your appointment there may be a cancellation fee.
-No piercing services or jewelry changes are currently available to anyone under the age of 13 years old.
-For minors 13 to 17 years old, the parent’s government issued photo ID and the minor’s birth certificate must be included on this release form. For legal guardians who are not the parent, please provide an official document proving guardianship in addition to the above requirements.
-The parent/guardian that signs the form must be present at the appointment and must provide their matching ID. This is for any piercing services, including jewelry changes.
-A cancellation fee of $5 to $20, depending on which procedure, may be charged for any no-shows, arrivals that are more than 5 minutes late, or late cancellations . You must cancel through the online booking system 12 hours prior to your appointment in order to avoid a cancellation fee. No messages or phone calls will be accepted for cancellations.
-No nose or mouth piercings or services are available until further notice. Unfortunately, we can’t perform any “under the mask” procedures. This includes jewelry changes.
-Please don’t bring a guest with you. We are not allowing guests with the exception of one parent accompanying a minor.
-A mask must be worn in the studio at all times, including during procedures.
-Masks with head loops instead of ear loops are greatly preferred for any ear piercing services.
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 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:
Prefered name:
Address:*
Date of birth:*
If you are under 18 your parent/guardian will be required
Phone #:*
Email:*
Signature:*


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