PIERCING CONSENT FORM | Solana Tattoo Co.

Solana Tattoo Company Piercing Consent Form

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IN CONSIDERATION OF the risk of injury that exists while participating in getting a piercing (hereinafter the “Activity”) from

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at Solana Tattoo Company; and IN CONSIDERATION OF my desire to participate in said Activity and being given the right to participate in same;

I HEREBY, for myself, my heirs, executors, administrators, assigns, or personal representatives (hereinafter collectively, “Releasor,” “I” or “me,” which terms shall also include Releasor’s parents or guardian if Releasor is under 18 years of age), knowingly and voluntarily enter into this WAIVER AND RELEASE LIABILITY and hereby waive any and all rights, claims or causes of action of any kind arising out of my participation in the Activity; and

I HEREBY release and forever discharge Solana Tattoo Company, located at 1119 W. Elizabeth St., Fort Collins, Colorado 80521, their affiliates, managers, members, contractors, agents, attorneys, staff, owners, volunteers, heirs, representatives, predecessors, successors and assigns (collectively “Releasees”), from any physical or psychological injury that I may suffer as a result of my participation in the aforementioned Activity.

I AM VOLUNTARILY PARTICIPATING IN THE AFOREMENTIONED ACTIVITY AND I AM PARTICIPATING IN THE ACTIVITY ENTIRELY AT MY OWN RISK. I AM AWARE OF THE RISKS ASSOCIATED WITH PARTICIPATING IN THIS ACTIVITY, WHICH MAY INCLUDE, BUT ARE NOT LIMITED TO:

PHYSICAL OR PSYCHOLOGICAL INJURY, PAIN, SUFFERING, ILLNESS, DISFIGUREMENT, TEMPORARY OR PERMANENT DISABILITY (INCLUDING PARALYSIS), ECONOMIC OR EMOTIONAL LOSS, INFECTION, SCARRING, DIFFICULTIES IN THE DETECTION OF MELANOMA, ALLERGIC REACTIONS TO SAID PIERCING SUPPLIES, JEWELRY, GLOVES, AND/OR SOAP, AND DEATH. I UNDERSTAND THAT THESE INJURIES OR OUTCOMES MAY ARISE FROM MY OWN OR OTHERS’ NEGLIGENCE, CONDITIONS RELATED TO TRAVEL TO AND FROM THE ACTIVITY, OR FROM CONDITIONS AT THE ACTIVITY LOCATION(S). NONETHELESS, I ASSUME ALL RELATED RISKS, BOTH KNOWN AND UNKNOWN TO ME, OF MY PARTICIPATION IN THIS ACTIVITY.

Having been informed of the potential risks associated with getting a piercing, I wish to proceed with the piercing procedure and application and freely accept and expressly assume any and all risks that may arise from the piercing.

I FURTHER AGREE to indemnify, defend and hold harmless the Releasees against any and all claims, suits or actions of any kind whatsoever for liability, damages, compensation or otherwise brought by me or anyone on my behalf, including attorney’s fees and any related costs.

I FURTHER ACKNOWLEDGE that Releasees are not responsible for errors, omissions, acts of failures or acts of any party of entity conducting a specific event of activity on behalf of Releasees. In the event that I should require medical care or treatment, I authorize Solana Tattoo Company to provide all emergency medical care deemed necessary, including but not limited to, first aid, CPR, the use of AEDs, emergency medical transport, and sharing of medical information with medical personnel.

I further agree to assume all costs involved and agree to be financially responsible for any costs incurred as a result of such treatment. I am aware and understand that I should carry my own health insurance.

I ACKNOWLEDGE that this Activity may involve a test of a person’s physical and mental limits and may carry with it the potential for death, serious injury, and property or job loss. I agree not to participate in the Activity unless I am medically able, mentally and physically, and I agree to abide by the decision of the Solana Tattoo Company official or agent regarding my approval to participate in the Activity.

Being of sound mind and body also means I am not under the influence or impaired by any alcohol, drugs or other mind-altering substances; I am of sound mind and body; and I am in good health.

Solana Tattoo Company has given me instructions on the care of my piercing while it's healing. I understand 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. If any rejection, scarring or infected piercing fixes are needed due to my own negligence, I agree that the work will be done at my own expense.

I do not suffer from diabetes, epilepsy, hemophilia, heart condition(s), nor do I take blood thinning medication. I do not have any other medical or skin condition that may interfere with the procedure, application or healing of the piercing. I am not the recipient of an organ or bone marrow transplant or, if I am, I have taken the prescribed preventative regimen of antibiotics that is required by my doctor in advance of any invasive procedure such as tattooing or piercing.

I am not pregnant or nursing. I do not have a mental impairment that may affect my judgment in getting the piercing.

I acknowledge a piercing is a permanent change to my appearance and can cause scarring/keloiding that can only be changed by surgical means, which can be disfiguring and/or costly and which in all likelihood will not result in the restoration of my skin to its exact appearance before before getting piercing.

I release the right to any photographs taken of me and the piercing and give consent in advance to their reproduction in print or electronic form. (For assurance, if you do not initial this provision, please inform Solana Tattoo Company NOT to take any pictures of you and your completed piercing).

I agree that Solana Tattoo Company has a NO REFUND policy on piercing and/or retail sales, and I will not ask for a refund for any reason whatsoever.

I agree to reimburse Solana Tattoo Company and piercing artist for any attorneys' fees and costs incurred in any legal action I bring against Solana Tattoo Company and in which either the Artist of Solana Tattoo Company is the prevailing party. I agree that the courts located in the County of Larimer within the State of Colorado shall have jurisdiction and venue over me and shall have exclusive jurisdiction for the purposes of litigating any dispute arising out of or related to this agreement.

I acknowledge that I have been given adequate opportunity to read and understand this document and that it was not presented to me at the last minute, and I understand that I am signing a legal contract waiving certain rights to recover damages against Solana Tattoo Company. 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.

Solana Tattoo Company has given me the full opportunity to ask any question about the procedure and application of my piercing and all of my questions, if any, have been answered to my total satisfaction.

I ALSO ACKNOWLEDGE that some locations on the body and different bodies may not hold a piercing well or may heal differently.

I have reviewed and approve of the location of the piercing on my body. If not yet placed, I agree that my verbal approval is my full consent.

I HEREBY ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS WAIVER AND RELEASE AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. I EXPRESSLY AGREE TO RELEASE AND DISCHARGE SOLANA TATTOO COMPANY AND ALL OF ITS AFFILIATES, MANAGERS, CONTRACTORS, MEMBERS, AGENTS, ATTORNEYS, STAFF, OWNERS, VOLUNTEERS, HEIRS, REPRESENTATIVES, PREDECESSORS, SUCCESSORS AND ASSIGNS FROM ANY AND ALL CLAIMS OR CAUSES OF ACTION AND I AGREE TO VOLUNTARILY GIVE UP OR WAIVE ANY RIGHT

THAT I OTHERWISE HAVE TO BRING A LEGAL ACTION AGAINST SOLANA TATTOO COMPANY FOR PERSONAL INJURY, PROPERTY DAMAGE OR OTHER DAMAGES.

To the extent that statute or case law does not prohibit releases for ordinary negligence, this release is also for such negligence on the part of Solana Tattoo Company, its agents, and employees/contractors.

I agree that this Release shall be governed for all purposes by Colorado law, without regard to any conflict of law principles. This Release supersedes any and all previous oral or written promises or other agreements.

In the event that any damage to equipment or facilities occurs as a result of my or my family’s or my agent’s willful actions, neglect or recklessness, I acknowledge and agree to be held liable for any and all costs associated with any such actions of neglect or recklessness.

THIS WAIVER AND RELEASE OF LIABILITY SHALL REMAIN IN EFFECT FOR THE DURATION OF MY PARTICIPATION IN THE ACTIVITY, DURING THIS INITIAL AND ALL SUBSEQUENT EVENTS OF PARTICIPATION.

THIS AGREEMENT was entered into at arm’s length without duress or coercion and is to be interpreted as an agreement between two parties of equal bargaining strength. Both I and Solana Tattoo Company agree that this agreement is clear and unambiguous as to its terms, and that no other evidence shall be used or admitted to alter or explain the terms of this agreement, but that it will be interpreted based on the language in accordance with the purposes for which it is entered into.

In the event that any provision contained within this Release of Liability shall be deemed to be severable or invalid, or if any term, condition, phrase or portion of this agreement shall be determined to be unlawful or otherwise unenforceable, the remainder of this agreement shall remain in full force and effect. If a court should find that any provision of this agreement is invalid or unenforceable, but that by limiting said provision it would become valid and enforceable, then said provision shall be deemed to be written, construed and enforced as so limited.

I hereby declare that I am of legal age (and have provided valid proof of age and identification) and am competent to sign this agreement.

I HAVE READ THE AGREEMENT, I UNDERSTAND IT, AND I AGREE TO BE BOUND BY IT.

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Electronic records will be retained. Printed or digital copy of this consent form are available for your records. Submitting this waiver signifies your intent to sign electronically and your consent to do business electronically. If you do not wish to do an electronic consent form, you may request a manual consent form.