In consideration of receiving a body piercing from, the name listed below, (hereinafter the "Piercer") at Attic Jewelry & Piercing together with its employee, apprentices and agents, I agree to the following:
1. I hereby declare that I am at least 18 years old (have provided valid proof of age) and competent to sign this Agreement or, if not, that my parent or legal guardian shall sign on my behalf, and that my parent or legal guardian is in competent understanding and concurrence with this agreement.
2. I do not have any of the following medical conditions: heart, epilepsy, hepatitis, diabetes, hemophilia, AIDS, HIV or any immune deficient condition. I am not under the influence of drugs or alcohol. I am not pregnant or nursing presently.
3. I do not have any physical, mental or medical impairment or disability which might affect my well-being as a direct result of my decision to have my body pierced.
4. I affirm that both piercer and Attic Jewelry & Piercing have given me instructions on the care of my piercing while it heals, and I understand them and agree to follow them. I agree that any reaction or rejection will be my own responsibility.
5. Being of sound mind and body, I hereby release any and all persons at Attic Jewelry & Piercing from all responsibility. I accept any and all responsibility myself for any consequence that might stem from my decision to have any piercing by Attic Jewelry & Piercing.
6. I agree not to sue Attic Jewelry & Piercing and/or its staff, past or present, for any damages, claims, demands, rights and causes of action of nature whatsoever for any injuries or property damages or death of myself or to any other person arising from my decision to have any piercing done at Attic Jewelry & Piercing by any person whomsoever.
7. I agree for myself, my heirs, my assignees, and legal representatives to hold Attic Jewelry & Piercing blameless for any damages, actions, causes of actions, claims of actions, lawsuits, costs of litigation, attorney's fees, and all costs and expenses whatsoever which might arise from my decision to have any piercing done by Attic Jewelry & Piercing, employees or corporate directors.
8. I agree to pay for any and all damages to any and all persons and property belonging to Attic Jewelry & Piercing, corporate directors and employees and to any other persons or companies which may become libel contractually or by operation of law, caused by, or resulting from my decision to have any piercing done by Attic Jewelry & Piercing, employees or corporate directors.
9. I agree that this waiver also pertains to and is designated to protect any and all establishments where Attic Jewelry & Piercing, corporate directors or employees conduct piercing.
10. I authorize Attic Jewelry & Piercing to use, display, edit and publish any and all photos taken of my piercing(s). I agree not to request any monies or gratuities from the use, display and publication of any or all photos taken by Attic Jewelry & Piercing.
11. I represent to Attic Jewelry & Piercing, corporate directors and employees that the following information is true and correct, I also agree to accept the Malaysia Law of Personal Data Protection Clause.
I HAVE READ THIS AGREEMENT; I UNDERSTAND IT AND I AGREE TO BE BOUND BY IT.