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Jewelry Change, Removal, Downsize

Let us do this part
Today's Date:
Mon Nov 18 2024 12:23
Practitioner:*
Service? Downsize, change, removal, stretch, or recovery?:*
Placement? Lobe, helix, nostril, etc.:*
Please attach your unexpired, government-issued photo ID, such as a driver's license. If any information is not accurate or the picture is not in focus, you may have to do the form again.

If you have any questions, comments, or concerns, please feel free to reach out at any time.

For more information, please see https://monarchpiercing.com/terms


** FOR MINORS --

Fill the client information with the minor's information. A dropdown will appear for parent/guardian information once their age is selected. When adding images of your IDs, include the birth certificate and/or other guardianship paperwork.

A button will show below your first uploaded image to "+ Another Photo" so that you may upload each necessary document.
Photo ID*
Please take photo(s) of your government issued photo IDs and related paperwork.
Please read and answer
 
Age of piercing*
How long have you had this piercing? (If answering for a minor, respond as the minor in question)
 
Y
N
Piercing closure*
Has the jewelry been out for any length of time prior to your arrival in the studio?

If YES, for how long has the jewelry been out?
Details:
 
Y
N
Fainting*
Are you prone to fainting ("passing out")? (If answering for a minor, respond as the minor in question)
Y
N
Medical/Skin Condition(s)*
Do you have any skin or medical condition(s) that could affect the piercing site or its healing?

(Answering YES does not inherently prevent someone from receiving the service, so please answer honestly!)

(If answering for a minor, respond as the minor in question)
Details:
 
Y
N
Age*
I have trustfully represented to the Piercing Studio that I am either at least 18 years of age or that I am an emancipated minor.

If I am signing/consenting for a minor, I agree I am the parent, legal guardian, or legal custodian of the individual being pierced. I, the undersigned, am fully aware that to falsify legal standing as to parentage or being the legal guardian or legal custodian is a Class C misdemeanor; and, Pursuant to ยง 40-35-111, a Class C misdemeanor means imprisonment for a period of no greater than thirty (30) days or a fine not to exceed fifty dollars ($50.00), or both.
Jewelry Selection*
If I believe the jewelry is not an appropriate size for any reason, I will let the Piercer/Piercing Studio know right away and take immediate action to correct it.

I understand that the jewelry for the piercing(s) may have been in part chosen by the Piercer, and the jewelry the Piercer chose for me is what they feel is the most appropriate size and style for the area and for any reasonably anticipated inflammation. I understand The Piercer and the Piercing Studio are not responsible for any incident or changes in my body that may cause this jewelry to no longer fit properly in any way.
Risks & Health*
I understand that risks associated with stretching and/or jewelry insertion/removal that I am requesting, known and unknown, can lead to injury, which include, but are not limited to, infection, scarring, keloid development, and allergic reactions.

I acknowledge the Piercer cannot determine whether any individual may have an allergic reaction to the jewelry in this piercing, and I further acknowledge that such a reaction is possible.

I understand that there is always a possibility of infection. I cannot hold the Piercer or the Piercing Studio responsible for an infection that develops as a result of my care or lack of care during healing. If I believe my piercing is infected, I will seek immediate treatment from a doctor.

To the best of my knowledge, I do not have any illness or medical condition(s) that may interfere with the procedure or healing of the piercing.

I acknowledge that the removal of jewelry is not a guarantee of skin restoration or freedom from infection or risk.

I acknowledge that stretching any piercing will result in a permanent change to my appearance and that skin may not be restored to its pre-piercing condition, even after its potential removal.

Having been informed of the potential risks associated with getting this service(s), I still wish to proceed with the stretch and/or jewelry insertion/removal, and I freely accept all risks that may arise from piercing.
Consent & Duress*
To the best of my knowledge, I do not have any mental impairment or disability which may affect my decision or ability to consent at this time.

I affirm that I (nor the minor, if applicable) am not currently under the influence of any alcohol or drugs.

I agree that receiving the service(s) is my (or the minor's) choice alone, and no one else is pressuring or coercing me (or the minor).
Aftercare*
I acknowledge that it is possible that the piercing can become problematic, even if previously healed, particularly if I do not follow the instructions.
Contact*
I give my explicit consent granting Monarch Fine Jewelry + Professional Piercing, the Piercer, the Piercing Studio, and its employees to contact me through email and phone, including text regarding services, appointments, jewelry, and other aspects pertaining to the business. I give my explicit consent granting Monarch Fine Jewelry + Professional Piercing, the Piercer, the Piercing Studio, and its employees to contact me through email and phone, including SMS and MMS messaging, regarding services, appointments, jewelry, and other aspects pertaining to the business. Monarch will never sell your information or use your information to send marketing emails, only those pertaining to your services and jewelry.

I understand the Piercing Studio does not have control over Square, Squarespace, or other companies/tools used by the Piercing Studio and the way in which they use data provided. If I wish to revoke the ability to be contacted, I must let the Piercing Studio know in writing, and this will not inherently remove what contact is done through the services of Square, Squarespace, or other companies/tools the Piercing Studio uses.
Photography
I grant the Piercing Studio permission to take and/or use my likeness in any photograph(s) in any way they choose. I release all rights to any photograph(s) taken of me and the piercing and give consent in advance to their reproduction in print or electronic form, including, but not limited to, social media. I will not make monetary or other claim(s) against the Piercing Studio, Piercer, or affiliates for the use of the photograph(s).
Payment*
I agree to pay for the services and jewelry in full via cash, check, an approved payment card, or other payment method determined by the Piercing Studio. I agree unconditionally that no refunds will be provided. Jewelry is warranted to be free from defects in materials or workmanship for life as determined by the manufacturer.
Legal Document*
The Piercer, the Piercing Studio, and its employees have given me full opportunity to ask any and all questions about the procedure, and they have been answered to my total satisfaction.

I acknowledge that I have been given adequate opportunity to read and understand this document.

I understand that I am signing a legal contract.
By signing, I agree to the following in addition to the above:

I agree to follow all Monarch Fine Jewelry + Professional Piercing guidelines, terms, conditions, and policies.

I understand that all guidelines, terms, conditions, and policies can be changed at any time.

I understand I and any individuals in my party must wear an earloop mask during the ENTIRETY of my appointment. Furthermore, I understand that any mask should fit snugly against the sides of the face while wrapping securely over the nose, mouth, and chin so as not to require any adjustment because of movement or speaking.

I understand that I agreed to the detailed list of terms and guidelines found at https://monarchpiercing.com/terms before booking.

If I have provided proof of vaccination, I agree that this information is true and correct. I agree that I am indeed fully vaccinated and the physician-directed time (2-3 weeks) have passed since I have received my single-shot dose of the Johnson & Johnson vaccine or the second shot of the Pfizer or Moderna vaccine.

Neither I nor any individuals with me have come into contact with someone who was exhibiting symptoms of COVID-19 within the past 21 days.

Neither I nor individuals with me are currently exhibiting ANY of the following symptoms:

fever or chills, cough, new shortness of breath or difficulty breathing, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, or new confusion.

I understand that Monarch Fine Jewelry + Professional Piercing has put in place preventative measures to reduce the spread of COVID-19, but that nonetheless, infection can occur anywhere. I understand no business can completely prevent someone from becoming infected. I understand being in any business or public place can potentially increase my risk of contracting COVID-19. I am aware of the highly contagious nature of COVID-19 and the risk that I may be exposed to or contract COVID-19 by entering the Piercing Studio or interacting with its employees or the Piercer.

I acknowledge that I am voluntarily entering the Piercing Studio with knowledge of the danger involved. I hereby agree to accept and assume all risks of personal injury, illness, disability, or death, including that related to COVID-19, arising from my being on the Premises or engaging in the Activity, whether caused by negligence of the Piercing Studio, its employees or affiliates, the Piercer, or otherwise.

I, the individual receiving services, and anyone claiming on my and/or the individual receiving the service(s)'s behalf, expressly release, waive, and forever discharge to the fullest extent permitted by law each Piercer, the Piercing Studio, its affiliates, successors and assigns, employees, representatives, partners, and anyone claiming through them from all liability whatsoever in their individual and/or corporate capacities, on account of injury, illness, disability, or death arising out of or attributable to my being on the premises of the Piercing Studio or engaging in the services and being exposed to or contracting COVID-19, whether arising out of the negligence of the Piercing Studio, its owners, employees, affiliates, officers, the Piercer, or otherwise.


I, the individual receiving services, and anyone claiming on my and/or the individual receiving the service(s)'s, behalf release, waive, and forever discharge to the fullest extent permitted by law each Piercer, the Piercing Studio, its affiliates, successors and assigns, employees, representatives, partners, and anyone claiming through them from all liability whatsoever in their individual and/or corporate capacities, for any and all claims or causes of action that I, my estate, heirs, executors, or assigns may have, for personal injury, damage, loss, or otherwise, including any direct and/or consequential damages which result, arise, or relate, whether caused by the negligence or fault of the Piercer, the Piercing Studio, its affiliates, successors and assigns, employees, representatives, partners, and anyone claiming through them, or otherwise.

I agree to reimburse each of the Piercer(s), the Piercing Studio, and the Studio employees for any attorney's fees and costs incurred in any legal action I and/or the person receiving services bring against the Piercer, the Piercing Studio, its affiliates, successors, employees, representatives, and anyone claiming through them in which the Piercer, the Piercing Studio, its affiliates, successors, employees, representatives, and anyone claiming through them is the prevailing party. I agree that the court(s) 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 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:*


Emergency Contact
If something happens, your emergency contact might need to explain your medical history, allergies, or medications.
Name:
Phone #: