The Galactic Gem

The Galactic Gem
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ACKNOWLEDGMENT, RELEASE & WAIVER OF LIABILITY(PLEASE INITIAL EACH LINE AFTER READING)
1. ACKNOWLEDGEMENT OF PROCEDURE & ENVIRONMENTI voluntarily request to receive a body piercing from The Galactic Gem. I acknowledge that the procedure will be performed in a clean, professional environment using sterile, single-use equipment.
2. UNDERSTANDING OF RISKSI have been informed of and understand the common risks associated with body piercing, which include, but are not limited to: pain, bleeding, bruising, swelling, infection, scarring, allergic reactions, nerve damage or irritation, and the rejection or migration of the jewelry. I understand that oral piercings carry specific risks, including gum recession, tooth chipping, and tooth damage. I understand that surface piercings have a significantly higher risk of rejection. I understand that initial jewelry is longer to accommodate swelling and must be downsized by the studio as directed. I acknowledge that jewelry quality and fit cannot be guaranteed long-term if my anatomy changes (e.g., weight fluctuation, aging).
3. LEGAL & HEALTH STATUSI am at least 18 years of age and have provided valid, government-issued photo ID, OR I have completed all required notarized parental consent forms. I am sober; I have not consumed alcohol or caffeine in the last 24 hours and will not consume any for 24 hours after the procedure. The ID I have provided is authenic and information is true/ correct. I have not taken blood-thinning medication (e.g., Aspirin, Ibuprofen) in the last 24 hours. I am not pregnant or nursing.
4. COMMUNICABLE DISEASE DISCLOSUREI have disclosed below and verbally to my piercer any known history of communicable diseases (e.g., HIV, Hepatitis A/B/C). I understand that non-disclosure does not void this waiver. Write N/A if none and Initial.
5. PROCEDURAL CONSENTI have inspected the jewelry and agreed to its type and placement before the procedure begins. I consent to necessary and incidental touching of sensitive areas required to perform the procedure safely and accurately. I consent to photography of my procedure and piercing for procedural, educational, or promotional purposes.
The Galactic Gem: 8326 consumer ct Sarasota Fl, 34202

The Galactic Gem
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6. AFTERCARE RESPONSIBILITY
I have received and understand the verbal and written aftercare instructions. I agree to follow them exactly. I accept full and complete responsibility for the aftercare and healing of my piercing. I agree to check my jewelry monthly for tightness and return for a downsize when advised (About 4 weeks.) I understand that any follow ups/ touch-ups or corrections needed due to my negligence or failure to follow aftercare instructions will be at my own expense. I agree that The Galactic Gem may update aftercare instructions based on the most current medical standards. I agree to notifiy The Galactic Gem of any issues that may occur in the healing process.
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7. NO GUARANTEE & LIMITATION OF LIABILITY
I understand that body piercings tattoos and body art are not guaranteed to heal perfectly or at all due to factors beyond the studios control, such as my own anatomy, hygiene, and aftercare practices, clothing etc. The Galactic Gem will provide aftercare instructions and, at its discretion, troubleshooting advice for common healing issues. I understand this advice is for informational purposes only and is not a substitute for the diagnosis or treatment of a licensed medical professional.
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8. COMPLETE RELEASE OF LIABILITY (HOLD HARMLESS AGREEMENT)
Being of sound mind and body, I hereby agree to release, discharge, and hold harmless "The Galactic Gem", its owners, employees, agents, and representatives from any and all claims, demands, damages, rights, causes of action, or liability of any kind arising from my decision to have this piercing/procedure, including any complications during or after the healing process. This release applies whether the claim is based on alleged negligence or any other cause of action, and it includes any injury, damage, or loss to myself or my property.
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9. STUDIO POLICIES & LEGAL TERMS
I understand that all sales are final. There are no refunds on services or jewelry once the procedure has begun. I understand a $25 reinsertion fee will apply if jewelry is lost or removed before the recommended healing time and must be reinserted. Reinsertion is not guaranteed if the channel has closed. I understand that The Galactic Gem reserves the right to refuse service to anyone at any time for any reason, including safety concerns, intoxication, or hostile behavior or any other reason. I agree that any legal disputes will be resolved in the courts of Manatee County, Florida.
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FINAL CLIENT CERTIFICATION
By signing below, I swear that all information provided is true and accurate. I have been given the opportunity to ask questions, which have been answered to my satisfaction. I have read, understood, and initialed each section of this agreement. I am not under the influence of alcohol or drugs. I consent to the piercing procedure voluntarily and agree to all terms outlined in this document.
Client Signature:

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Date:

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Date
Parent/Guardian Signature (if minor):

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Date:

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Date
The Galactic Gem: 8326 consumer ct Sarasota Fl, 34202
FOR STUDIO USE ONLY:
Florida Establishment License #:
Time Out:
Complications/Notes:
The Galactic Gem: 8326 consumer ct Sarasota Fl, 34202
Signature Person getting pierced

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Signature Piercer

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Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
sex race.
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Client Intake, Consent & Release Form

CLIENT INFORMATION

PIERCING DETAILS

HEALTH HISTORY (Please write clearly)

EMERGENCY & PHYSICIAN CONTACT (NOT 911)

ACKNOWLEDGMENT, RELEASE & WAIVER OF LIABILITY(PLEASE INITIAL EACH LINE AFTER READING)

6. AFTERCARE RESPONSIBILITY

7. NO GUARANTEE & LIMITATION OF LIABILITY

8. COMPLETE RELEASE OF LIABILITY (HOLD HARMLESS AGREEMENT)

9. STUDIO POLICIES & LEGAL TERMS

FINAL CLIENT CERTIFICATION

FOR STUDIO USE ONLY: