Revel Road Device Piercing Waiver

REVEL ROAD EAR PIERCING WAIVER, RELEASE AND CONSENT FORM
If the individual receiving the piercing (the "Customer") is under 18, this form must be completed and signed by a parent or legal guardian on behalf of the Customer and the pronoun “I” throughout this form will refer to the Customer and the parent or legal guardian, as the context requires.

*Customer Information Recorded Below.

HEALTH RISK ADVISORY & DISCLOSURES
I understand that ear piercing involves inherent health risks including, but not limited to:

• Allergic reactions

• Skin infections and tissue damage

• Nerve damage

• Prolonged bleeding and swelling

• Hypertrophic scarring or keloid formation

• Pain and general discomfort

• Febrile illness, tetanus, or systemic infection

• Potential complications in identifying skin conditions in pierced areas

Medical Conditions That May Increase Risk: The following medical conditions or circumstances may increase the risk of complications from ear piercing:

• Diabetes

• Hemophilia or bleeding disorders

• Heart disease

• Skin disorders, diseases, lesions, or sensitivities to soaps/disinfectants

• Skin cancer or melanoma

• Allergies or sensitivities to metals, pigments, dyes, or latex

• Anaphylactic reactions or severe allergies

• Epilepsy, seizures, fainting, or narcolepsy

• Peripheral nerve disease

• Immune system or circulatory system deficiencies

• Use of anticoagulants or medications that thin blood or interfere with clotting

• Hepatitis or HIV

• History of infection

• Pregnancy or breastfeeding

• Any condition affecting the immune system

• Any other known or unknown medical condition

I hereby acknowledge that:

• I have been advised to consult with a physician prior to this procedure if the Customer falls into any heightened risk categories.

• If I have any medical conditions, including but not limited to those listed in the HEALTH RISK ADVISORY & DISCLOSURES section, I have consulted with a physician and received approval to proceed with the piercing.

• If I am taking blood-thinning medications, antibiotics, have diabetes, have a history of infection, or have any other medical condition that may increase risk, I have consulted with a physician and received approval to proceed with the piercing.

• I have truthfully and fully disclosed all relevant medical information and history to Revel Road staff.

• I am NOT under the influence of alcohol or drugs.

• I have NOT taken anticoagulants, antiplatelet drugs, or NSAIDs (aspirin, ibuprofen, etc.) in the last 24 hours.

• I am voluntarily choosing to proceed with knowledge of these risks.

EQUIPMENT & PROCEDURE

I understand that:

• My ears will be pierced with pre-sterilized, single-use ear piercing earrings packaged in sealed containers

• All equipment will be properly cleaned and sanitized

• Sterile techniques will be used

• The piercing practitioner will properly cleanse the area before the procedure

PERMANENCE & AFTERCARE

Permanence: Body piercing procedures are permanent in nature and may leave visible scarring.

Aftercare Responsibility:

• I understand the importance of proper aftercare in reducing the risk of infection or other medical complications

• Despite best efforts and proper aftercare, the potential for infection still exists

• Improper aftercare/hygiene, metal sensitivity, or other causes may increase the risk of infection

• Certain medical conditions, medications, and treatments can impede healing

• Healing times cannot be guaranteed

• I have read, understand, and agree to follow the EAR PIERCING AFTERCARE INSTRUCTIONS provided to me both verbally and in writing

• Since Revel Road x Studex will not monitor my at-home aftercare, it is solely my responsibility to follow the aftercare instructions

I should consult a healthcare provider for:

• Unexpected redness, tenderness, or swelling at the piercing site

• Rash or unexpected drainage

• Fever within 24 hours of piercing

• Any signs of infection, allergic reaction, or adverse reaction

BLOOD DONATION NOTICE

Obtaining any body piercing may disqualify you as a blood donor according to the standards of the American Association of Blood Banks, either temporarily or permanently.

JEWELRY CHANGE (If Applicable)

For jewelry change appointments, Revel Road x Studex shall not be held liable for any damage that may occur to non-Revel Road/non-Studex jewelry. By signing this waiver, you acknowledge that Revel Road x Studex and its agents will not be responsible for any such damage.

PHOTOGRAPHIC RELEASE

I grant permission and consent to Revel Road for the use of close-up photographs of the completed piercing for presentation under any legal condition, including but not limited to publicity, copyright purposes, illustration, advertising, marketing, social media, and web content.

Furthermore, I authorize Revel Road to take photographs and/or videos of my piercing procedure for internal training, quality assurance, and educational purposes.

I understand there shall be no payment, royalties, or other compensation for this release.

RELEASE OF LIABILITY / WAIVER OF CLAIMS

In signing this Release of Liability/Waiver of Claims, I hereby acknowledge and represent that:

I HAVE READ THIS RELEASE, UNDERSTAND IT, AND SIGN IT VOLUNTARILY.

If I am 18 years of age or older:

• I hold only myself liable and hereby release and waive any and all claims, known or unknown, arising out of or relating to this ear piercing, including claims of negligence, that I may have against Revel Road, STUDEX, their agents, contractors, and employees with respect to this ear piercing

• The foregoing release is intended to benefit all of the named parties, and will be enforceable by such parties, as third-party beneficiaries

• I hereby agree to accept and assume all risks of illness, personal injury, psychological injury, pain, suffering, disability, death, property damage, and/or financial loss arising from this piercing procedure

If I am the parent or legal guardian of a minor under 18:

• I hold only myself liable and hereby release and waive any and all claims, known or unknown, arising out of or relating to this ear piercing, including claims of negligence, that I or the minor may make as a result of this ear piercing against Revel Road, Studex, their agents, contractors, or employees.

• The foregoing release is intended to benefit all of the named parties, and will be enforceable by such parties, as third-party beneficiaries.

• I understand that Revel Road reserves the right to refuse to perform piercing on any minor at any time and for any reason.

I acknowledge that I am aware of and intentionally waive any rights I may have under statutes like California Civil Code § 1542, which provides: “A general release does not extend to claims that the . . . releasing party does not know or suspect to exist in his or her favor at the time of executing the release and that, if known by him or her, would have materially affected his or her settlement with the . . . released party.” I expressly waive and relinquish all rights and benefits under that section and any law of any jurisdiction of similar effect with respect to the claims released herein.

Indemnification: I further agree that should I, my child, or anyone else make a claim against Revel Road, STUDEX, their agents, contractors, or employees, for compensation for damages or harm allegedly incurred because of negligence or other alleged actions, I shall indemnify, defend and hold harmless Revel Road, STUDEX, their agents, contractors, and employees, against all such claims and associated costs, including any attorney fees incurred in defending against such claims.

Additional Acknowledgments:

• For purposes of signing this release, I understand that a fraudulent act is committed if either (i) a minor represents that he or she is an adult, or (ii) I falsely represent that I am the parent or legal guardian of a minor

• I understand that I must carefully follow all aftercare instructions and hereby release Revel Road, STUDEX and any partners from any claims resulting from my failure to follow procedures

• This waiver does not extend to claims for gross negligence, willful misconduct, or any other liabilities that law does not permit to be released by agreement

• All information I have provided is true and correct

• The Customer willingly submits to this piercing procedure

Severability: I expressly agree that this Release of Liability/Waiver of Claims is intended to be as broad and inclusive as permitted by law. If any provision is held invalid or otherwise unenforceable, the remaining provisions shall remain enforceable.

Privacy: No personal information provided within this waiver will be shared with any third party unless required by law.

Venue; Waiver of Jury Trial: I agree that any action or proceeding arising out of or relating to this Ear Piercing Waiver, Release and Consent Form shall be brought exclusively in the courts of Maricopa County, Arizona, and I waive any right to a jury trial in connection with any such action or proceeding.

Entire Agreement; Interpretation: This Ear Piercing Waiver, Release and Consent Form constitutes the entire agreement between the parties concerning the subject matter hereof and supersedes all prior agreements, understandings, negotiations, and discussions, whether oral or written, between the parties. No amendment, modification, or waiver of any provision of this form shall be effective unless in writing and signed by both parties. This form will not be interpreted against Revel Road as the drafter. 

SIGNATURE

I, the undersigned, acknowledge that I have read this Ear Piercing Waiver, Release and Consent Form in its entirety, fully understand and agree to its contents, and hereby grant consent to perform the ear piercing described above.