Studex Ear Piercing Release And Consent Form from J'Vita

Studex After Ear Piercing Release Form

Sterilization Lot Number

The undersigned, as a material consideration and inducement for agreeing

to pierce the undersigned ears, hearby releases and forever discharges

Studex, the original manufacturer, it's distributors, their employees and affiliated companies of and from all manners of actions

causes and demands in law or in equality which I or my heirs, executors or administrators have or might now or hereafter by

reason of their complying with my request to pierce my ears.

I acknowledge that I am not suffering from diabetes, allergies, or discoloration, swelling, lumps or signs of irritation of the

ear lobes. These studs are not designed for nose piercing.

Furthermore, I realize the importance of proper care in permitting my ears to heal without infection and promise to follow

faithfully the instructions given to me in writing.

You must be 18 years old or over to have your ears pierced without your parents consent. Your signature on the bottom

indicates that you are over 18.

I have read and fully understand all of the above instructions. I agree to follow each step of ear care exactly and I acknowledge

the importance of these instructions in maintaining healthy ears.

My failure to follow the instructions may lead to irritation or infection of my ears.

If under 18 years old: I have read the above. I am the child's parent or legal guardian and I consent to having their ears pierced.

Waiver courtesy of J'Vita Spa Line And downloaded from http://www.spaline.ca/studex_waver.html