EXPRESSION BODY ART
Permanent Jewelry Consent & Service Acknowledgment
Client Information
Full Name: _________________________________________________
Date of Birth: ______________________
Phone: ____________________________________________________
Email: _____________________________________________________
Date of Service: ____________________________________________
Jewelry Location:
☐ Bracelet ☐ Anklet ☐ Necklace ☐ Other: _______________
Chain/Style Selected: ________________________________________
Charms/Connectors: __________________________________________
Permanent Jewelry Acknowledgment
Please initial each statement:
_____ I understand that permanent jewelry is a clasp-free piece of jewelry that is custom-fitted and welded closed.
_____ I have reviewed and approved the fit and placement of my jewelry before the final weld is completed.
_____ I understand that my chain will be measured and cut specifically for me and that once the chain has been cut, the permanent jewelry purchase is final and non-refundable.
_____ I understand that “permanent” jewelry is not indestructible. The jewelry may break, stretch, snag, become damaged, discolor, or experience normal wear over time depending on the material, activities, environment, and care.
_____ I understand that a chain breaking does not necessarily indicate a defect and that jewelry is capable of breaking when subjected to sufficient force.
Welding Consent
_____ I voluntarily authorize Expression Body Art to fit, cut, and weld the permanent jewelry I have selected.
_____ I understand that the welding process closes a small connecting ring in the jewelry and that the jewelry is not welded to my skin.
_____ I understand that appropriate precautions will be taken during the welding process but acknowledge that permanent jewelry application involves equipment capable of producing heat and sparks.
_____ I agree to follow the instructions of the jewelry artist during the welding process.
Metal Allergies & Sensitivities
_____ I have informed Expression Body Art of any known metal allergies or sensitivities that I believe may be relevant to my jewelry selection.
_____ I understand that individual reactions to metals and jewelry materials can vary and that Expression Body Art cannot guarantee that a particular material will be suitable for every individual.
Known metal allergies/sensitivities:
☐ None known
☐ Yes — Please explain: ________________________________________
I understand that if I experience significant or persistent irritation or another unexpected reaction, I may need to remove the jewelry and seek appropriate medical advice if necessary.
Breakage & Repair Policy
_____ I understand that if my permanent jewelry breaks within 30 days of the original service date, Expression Body Art will provide one complimentary repair or reweld, provided I retain the original jewelry and it remains in repairable condition.
_____ I understand that after 30 days, repair or rewelding may be available for a $20 service fee.
_____ I understand that the service fee covers the repair/rewelding service and does not include replacement chains, charms, connectors, gemstones, or other materials.
_____ I understand that lost jewelry or components are not covered by the complimentary repair policy.
_____ I understand that if my jewelry breaks, I should retain the chain and any charms or connectors so Expression Body Art can determine whether it can be repaired.
Removal
_____ I understand that permanent jewelry can be removed if necessary.
If removal is required, I understand that whenever possible I should carefully cut the small connecting jump ring rather than the chain itself, which may allow the jewelry to be rewelded later.
_____ I understand that intentionally removed jewelry may be reapplied, when appropriate, for the applicable $20 service fee.
Medical, Workplace & Activity Considerations
_____ I understand that permanent jewelry may need to be removed for certain medical procedures, diagnostic testing, surgeries, employment requirements, school requirements, sports, or other activities.
_____ I understand that I am responsible for determining whether permanent jewelry is permitted in my workplace, school, athletic activities, medical circumstances, or other environments.
_____ I understand that instructions from my physician, healthcare facility, employer, school, or other applicable authority take priority over keeping my permanent jewelry in place.
Care & Responsibility
_____ I understand that proper care can affect the appearance and longevity of my jewelry.
_____ I understand that chemicals, cleaning products, cosmetics, lotions, pools, hot tubs, saltwater, physical activity, snagging, excessive pulling, and other environmental or lifestyle factors may affect jewelry differently depending on its material.
_____ I understand that normal wear, scratching, tarnishing or discoloration where applicable, and gradual changes in appearance are not necessarily considered defects.
Optional Photography Consent
Photography permission is optional and is not required to receive permanent jewelry services.
Please select one:
☐ YES — I authorize Expression Body Art to photograph my completed permanent jewelry and use the photographs on its website, social media, portfolio, advertising, or other promotional materials.
☐ YES — JEWELRY ONLY — Photographs may be used as long as my face or other personally identifying features are not shown.
☐ NO — I do not authorize photographs of me or my permanent jewelry to be used for promotional purposes.
Client Initials: __________
Client Consent & Authorization
By signing below, I acknowledge that:
I have read and understand this Permanent Jewelry Consent & Service Acknowledgment. I have had an opportunity to ask questions before receiving the service, and my questions have been answered to my satisfaction.
I voluntarily authorize Expression Body Art to measure, fit, cut, and weld the permanent jewelry I have selected.
I acknowledge the permanent jewelry’s custom nature, final-sale status, care requirements, potential for breakage, removal considerations, and Expression Body Art’s repair and service policies.
I certify that the information I have provided is accurate to the best of my knowledge.
Client Printed Name: __________________________________________
Client Signature: _____________________________________________
Date: __________________________ Time: ______________________
Expression Body Art Representative
Printed Name: _________________________________________________
Signature: ____________________________________________________
Date: ________________________________________________________
For a minor
Since you may eventually have parents bringing children or teenagers in for permanent jewelry, I would also put this small section at the bottom of the form:
Parent/Legal Guardian Authorization — If Applicable
I certify that I am the parent or legal guardian of the minor named above and authorize Expression Body Art to provide the permanent jewelry service described in this form.
Parent/Guardian Name: _________________________________________
Relationship to Client: ________________________________________
Parent/Guardian Signature: ____________________________________
Date: ______________________