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0 0 Union Tattoo & Piercing ***How did you hear about us? Waiver,Release,and Consent rof Piercing THIS DOCUMENT IS 2 PAGES(OR 2 SIDED).PLEASE INITIAL EACH PROVISION ON THE LINES PROVIDED AFTER READING TO SHOW THAT YOU UNDERSTAND EACH PROVISION.IF YOU ARE A MINOR THIS FORM MUST BE COMPLETED AND INTIALED BY YOUR PARENT(GUARDIAN)AS WELL. In consideration of receiving a body piercing from (the piercer)at Union Tattoo&Piercing (together with its employees,apprentices,and agents,the piercing studio),I agree to the following: That L (clearly print vour name)have been fully informed of the Inherent risks associated with getting a piercing.I fully understand that these risks,known and unknown can lead to injury,including but not limited to infection,scarring and keloding,allergic reactions to jewelry,latex gloves,and/or soap.Having been informed of the potential risks associated with getting a piercing,I still wish to proceed with the piercing and I freely accept and expressly assume any and all risks that may arise from the piercing. --/—To WAIVE AND RELEASE to the fullest extent permitted by law each of the Artist and the Piercing Studio 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 damr-agm —/—That both the Artist and Piercing Studio have given me the full opportunity to ask any and all questions about the piercing procedure and the staff has answered these questions to my total satisfaction. _/__J affirm that both the Artist and Piercing Studio have given me instructions on the care of my piercing while it's healing,and I understand them and will follow them.I acknowledge that it is possible that the piercing can become infected,particularly if I do not follow the instructions given to me. affirm that!am not under the influence of alcohol or drugs,and I am voluntarily getting piercing without duress. I Il --/—I acknowledge that the piercing will result in a permanent change to my appearance and that my skin may not be restored to its pre-piercing condition even after removal. —/—I release all rights to any photographs taken of the piercing and me and give consent in advance to their reproduction in print or electronic form.(If you do not initial this provision,please advise and remind your Artist and the Piercing Studio NOT to take any pictures of you and your completed piercing!) _/_J acknowledge that I have been given adequate opportunity to read and understand this document,that it was not presented to me at last minute,and I understand that I am signing a legal contract waving certain rights to recover against the Piercing Studio. agree to reimburse each of the Artist and Piercing Studio for any attorney's fees and costs incurred in any legal action I bring against either the Artist or Piercing Studio and in which either the Artist or the Piercing Studio is the prevailing party.I agree that the courts of California in San Joaquin County shall have personal jurisdiction and venue over me and shall have exclusive jurisdiction for the purpose of litigating any dispute arising out of or related to this agreement If any provision,section,subsection,clause,or phase of this release if found to be unenforceable or invalid,that portion shall be severed from this contract The remainder of this contract will then be constructed as though the unenforceable portion had never been contained in this document. —/—I hereby declare that I am of legal age(and have provided 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. If I feel/see any infection symptoms,I will consult with my primary care doctor.