Waiver For Ear Piercings

Disclosures, Agreements, Acknowledgments & Release

Health Risk Advisory. I understand that there are inherent health risks associated with ear piercing including, but not limited to, allergic reactions, skin infections, tissue damage, nerve damage, prolonged bleeding, swelling, hypertrophic scarring, a decreased ability of physicians to locate skin melanoma in regions concealed by body art, febrile illness, tetanus, systemic infection, keloid formation, pain, and general discomfort. Such complications may occur at the location of the piercing or elsewhere on the body. There are increased risks for adolescents during certain stages of development.

Additionally, existing medical conditions, or a history of certain medical conditions, such as allergies; heart disease; diabetes; hemophilia (bleeding); skin disorders; skin disease; skin lesions; skin sensitivities to soaps, disinfectants, etc.; skin cancer; allergies, anaphylactic reaction, or other adverse reaction to pigment, dyes, or other sensitivities; epilepsy, seizures, fainting, or narcolepsy; peripheral nerve disease; any deficiency of the immune or circulatory system; use of medications such as anticoagulants, which thin the blood or interfere with blood clotting; hepatitis; HIV; a history of infection; pregnancy; conditions that affect the immune system; or any other known or unknown medical condition may increase the risk of complications from ear piercing. I hereby represent that I have been advised to consult with a physician prior to the procedure if the Customer falls into any of the above heightened risk categories; and that I have consulted with a physician regarding any concerns I may have regarding the potential health risks that obtaining the above-described piercing may pose to the Customer.

NOTWITHSTANDING THESE RISKS, I ACKNOWLEDGE THAT I AM VOLUNTARILY CHOOSING TO PROCEED WITH THE PIERCING PROCEDURE WITH KNOWLEDGE OF THE RISKS INVOLVED.

For Customers in Texas: Report any diagnosed infection, allergic reaction, or adverse reaction resulting from the piercing to the artist and to the Texas Department of State Health Services at 1-888-839-6676.

Notice Regarding Permanence of Body Piercing. Body piercing procedures are permanent in nature and may leave visible scarring.

Aftercare. I understand and acknowledge the importance of proper aftercare in reducing the risk of infection or other medical complications following any piercing procedure. I understand that, despite Lark & Berry’s best efforts and the Customer’s proper aftercare, the potential for infection or other medical complications still exists. I also acknowledge that certain known or unknown medical conditions, medications, and medical treatments can impede the healing process, and therefore Lark & Berry cannot guarantee healing times. I have read, understand, and agree to follow each step of the instructions regarding Piercing Aftercare which has also been explained to me verbally. Further, I understand that since Lark & Berry will not have the opportunity to monitor my at-home aftercare, it is solely my responsibility to follow the Piercing Aftercare instructions provided at the time of the ear piercing.

Release of Liability/Waiver of Claims. 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 the above-described piercing procedure. I hereby expressly waive and release any and all claims, now known or hereafter known, against Lark & Berry, LB Culture LLC, its officers, managers, agents, employees, directors, representatives, independent contractors, retail partners, affiliates, successors, and assigns (collectively “Releasees”) on account of personal or psychological injury, illness, pain, suffering, disability, death, property damage, or financial loss arising out of or attributable to the ear piercing, whether arising out of the ordinary negligence of Lark & Berry, LB Culture LLC, or any Releasees, my failure to carefully adhere to all aftercare instructions, or otherwise. I covenant not to make or bring any such claim against Lark & Berry, LB Culture LLC, or any other Releasee, and forever release and discharge Lark & Berry, LB Culture LLC, and all other Releasees from liability under such claims. This waiver and release does not extend to claims for gross negligence, willful misconduct, or any other liabilities that state law does not permit to be released by agreement.

Other. This Ear Piercing and Aftercare Waiver, Release, and Consent Form (the “Agreement”) constitutes the sole and entire agreement of Lark & Berry, LB Culture LLC, and the signatory below with respect to the subject matter contained herein and supersedes all prior and contemporaneous understandings, agreements, representations, and warranties, both written and oral, with respect to such subject matter. No personal information provided within this waiver will be shared with any third party, unless required by law. I expressly agree that this Agreement is intended to be as broad and inclusive as permitted by the laws of the State of Texas, and that this Agreement shall be governed by and interpreted in accordance with the laws of the State of Texas, unless applicable law requires otherwise. I agree that in the event that any clause or provision of this Agreement shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining provisions of this Agreement which shall continue to be enforceable.

I, the undersigned, acknowledge and agree that I have read this Ear Piercing and Aftercare Waiver, Release, and Consent Agreement in its entirety, fully understand and agree to its contents. I confirm that the information herein regarding health conditions which may increase any health risks associated with this piercing have been explained to me verbally; that the Customer does not have any health conditions that would prevent the Customer from receiving the piercing procedure described herein; and hereby grant Lark & Berry, LB Culture LLC consent to perform the ear piercing described above on the Customer. I understand that Lark & Berry, LB Culture LLC will not perform the requested piercing services unless this form is completed in its entirety and signed by me. I further represent and warrant that all information set forth above is true and correct, and that the Customer willingly submits to the piercing procedure described herein.

Lark & Berry

A DBA of LB Culture LLC

Address: 2630 Richmond Ave, Houston, TX, 77098

Phone: 713-836-1379