RION Piercing Procedure

Ask a staff member what to enter
Today's Date:
Mon May 20 2024 03:04
Body Piercing Location:*
Body Piercing Price:*
RION Body Piercing Release Form
Please read and answer
General
This RION Piercing Procedure Release Form (this “Agreement”) is entered by DBA RION Jewelry (“RION"), a Washington limited liability company, and the undersigned ("I" “my” “you” “your” “Client"). RION offers body piercing, jewelry installation, jewelry removal and jewelry changing services to its clients (“Services”). The Services are offered to Client under the terms of this Agreement.
Valid Photo ID, 18+ years old*
You verify that you are 18 years or older, and have provided a current, non-expired, valid government issued photo ID confirming this.
For Parent or Legal Guardian
If you are a parent or legal guardian accompanying a minor under 18 years of age for a procedure(s), proof of relationship such as a birth certificate, insurance card, or guardianship affidavit is also required.
Y
N
On Behalf of a Minor
If you are a parent or legal guardian completing this form because the individual undergoing the procedure(s) is a minor under 18 years of age, please answer the questions and acknowledgements below on their behalf, as they pertain to that individual’s body and understanding. BY SIGNING THIS AGREEMENT, YOU CERTIFY THAT YOU UNDERSTAND THE NATURE OF THE SERVICE AND CONSENT FOR RION TO PERFORM THE SERVICE FOR YOUR CHILD OR THE CHILD UNDER YOUR CARE.
 
Pronoun(s)
 
Recent Symptoms*
I certify that neither I, nor any member of my household are experiencing symptoms of a viral infection such as COVID-19, including fever, loss of taste or smell, dry cough, running nose, sore throat, or shortness of breath.
Y
N
Eaten*
Have you eaten in the last 4 hours? It is a good idea to eat beforehand to increase your blood sugar levels.
Not Pregnant*
I verify I am not pregnant.
Y
N
Alcohol or Narcotics*
Have you had any alcohol or narcotics in the last 8 hours? I certify that I have not consumed alcohol or narcotics within the last 8 hours. Further, RION reserves the right to refuse to provide the Service for any reason including the appearance of intoxication.
Y
N
Allergies*
Do you have any allergies? If so, to what? I certify that I am not allergic to the material from which my jewelry is made which may include gold, silver, and other materials.
Details:
 
Y
N
Bleeding*
Are you prone to heavy bleeding?
Y
N
Fainting*
Are you prone to fainting?
Y
N
Health Conditions*
Do you have a history of any medical illness or conditions?
Details:
 
Y
N
Medications*
Have you taken any medications or have any conditions that can thin your blood?
Details:
 
Y
N
Scarring*
Are you prone to scarring?
Not a Medical Facility*
ou understand, acknowledge, and agree that RION is not and shall not act as a medical facility.
Permanent Change*
You understand that this is a permanent change to my body that cannot be undone. I consent to this change.
Aftercare*
You understand that once you leave the facility, the aftercare of this piercing is your own responsibility, for which RION and RION staff, artists, and piercers are not responsible.
Release of Liability*
The Client forever waives, releases and discharges RION, their agents, employees, independent contractors, and representatives affiliated with this studio (“Releasees”) from any and all claims, demands, liabilities and/ or damages whatsoever to the fullest extent of the law whether arising from negligence or in any other manner. The undersigned hereby voluntarily assumes any and all risk of injury and/ or damages resulting from or in connection with the procedure. The undersigned further agrees to indemnify and do indemnify the Releasees from any and all claims, demands, actions, liability and/ or damages whatsoever whether arising from negligence or in any other manner made by any individual or entity arising from or relating to the services performed under this agreement. The indemnification shall include, but not be limited to any and all attorney's fees and costs incurred. I HAVE READ AND UNDERSTAND THIS ENTIRE DOCUMENT. I UNDERSTAND THAT IT CONTAINS A RELEASE OF ALL CLAIMS, WAIVER OF LIABILITY, MY ASSUMPTION OF ALL RISK, AND AN AGREEMENT FOR INDEMNIFICATION.
Severability*
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.
Entire Agreement
This Agreement constitutes the full and complete understanding between RION and Client. Any other oral or written prior agreements or understandings are superseded hereby. Any amendment to this Agreement must be in writing signed by all parties.
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:*
Chosen name:
Address:*
Postcode:
Date of birth:*
If you are under 18 your parent/guardian will be required
Phone #:*
Email:*
Sign up for our newsletter
Signature:*


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