Name *

First Name

Last Name

Phone *

(###)

###

####

Do you have any of the following? *

Pacemaker

Allergy/Sensitivity to metal

Any other condition that would make this permanent jewelry experience unsafe?

None of the above

Today's Date *

MM

DD

YYYY

Release and Waiver of Liability *

All of my questions regarding permanent jewelry have been answered by RENUED LLC to my satisfaction. I understand that all RENUED LLC jewelry is final sale. I understand that this jewelry can break and/or stretch if pulled or caught. I understand that this permanent jewelry can easily be removed. I understand how to take proper care of my permanent jewelry. I understand that RENUED LLC guarantees the weld but not the chain or jewelry itself. I acknowledge that I do not have a pacemaker, a sensitivity or allergy to any metals, or have any other condition that might make this permanent jewelry experience unsafe. By signing this form, I acknowledge and accept that RENUED LLC is not liable for any medical condition or injury caused by this experience or jewelry. I understand that permanent jewelry or any jewelry piece can be a danger to young children. I understand that RENUED LLC is not liable for any injuries or reactions that may occur. I grant RENUED LLC permission to capture images and likeness in photographs, videotapes, and/or digital media. A parent/guardian signature is required if under the age of 16.

Yes, I agree and acknowledge the release and waiver of liability