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Permanent Jewelry
Let us do this part
Today's Date:
Sat May 2 2026 07:12
Practitioner:*
Please read and answer
Y
N
I acknowledge by signing this release that I have been given the full opportunity to ask any and all questions which I may have about obtaining permanent jewelry by MARAH LANDRY and all questions have been answered to my full and total satisfaction.
Y
N
I understand that there is always a risk of allergic reaction to the metals, although rare.
Y
N
I understand that the procedure/application may require welding, which does have potential risks (irritation, discomfort, burns, scarring)
Y
N
I agree to the jewelry aftercare instructions/suggestions provided to me.
Y
N
I understand that although the jewelry is intended to be permanent, the longevity of my jewelry can vary based on factors in my daily life. I also understand that some procedures (like surgery) may require removal of my permanent jewelry.
Y
N
I understand that if my jewelry becomes broken AT THE WELD, I am able to get it replaced free of charge for up to 30 days. Breaks not on the weld are an additional fee to fix.
Y
N
I give consent in advance to have my photograph taken and the potential 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 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:*
Pronouns:
Chosen name:
Address:*
Postcode:*
Date of birth:*
 
If you are under 18 your parent/guardian will be required
Age: 
Phone #:*
Email:*
Signature:*

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