Piercing Consent Form

In consideration of receiving a piercing from Avanti Tattoo including its artists, piercers, associates, apprentices, agents, or any employees (hereinafter referred to as the “Piercing Studio” I agree to and acknowledge the following:

I understand there are inherent risks associated with the piercing procedure, known and unknown, that can lead to injury, including but not limited to: infection, scarring, and allergic reactions. Having understood the potential risks associated with the piercing procedure, I wish to proceed with the piercing procedure and freely accept and expressly assume any and all risks that may arise from the piercing procedure.

I WAIVE AND RELEASE to the fullest extent permitted by law any person of the Piercing Studio from all liability whatsoever, including but not limited to, any and all claims or causes of action that I, my estate, heirs, executors or assigns may have for personal injury or otherwise, including any direct and/or consequential damages, which result or arise from the piercing procedure, whether caused by the negligence or fault of either the Piercing Studio, or otherwise.

I understand that I need to follow the instructions the Piercing Studio provides me regarding the care of my piercing while it's healing and I agree to follow those instructions. I acknowledge that it is possible for the piercing to become infected, particularly if I do not follow the instructions given to me.

I certify that I am not under the influence of alcohol or drugs, and that I am voluntarily submitting to being pierced by the Piercing Studio without duress or coercion.

I acknowledge that the Piercing Studio has a NO REFUND policy on the piercing procedure and I will not ask for a refund for any reason whatsoever.

I release the right to any photographs taken of me and my piercing and give consent in advance to their reproduction in print or electronic form.

I agree to reimburse the Piercing Studio for any attorneys' fees and costs incurred in any legal action I bring against the Piercing Studio and in which either the piercer or the Piercing Studio is the prevailing party. I agree that the courts located in the County of Eagle within the State of Colorado shall have jurisdiction and venue over me and shall have exclusive jurisdiction for the purposes of litigating any dispute arising out of or related to this agreement.

Do you have Hemophilia?*

YesNo

Do you have a history of Keloiding scar tissue?*

YesNoNot Sure

Please provide details.

Do you have a history of rejected piercings?*

YesNo

Please provide details.

Are you being treated with anticoagulants or other medications that thin the blood and/or interfere with blood clotting?*

YesNo

Please provide details.

Do you have allergies or adverse reactions to latex, pigments, dyes, disinfectants, soaps, or metals?*

YesNo

Please provide details.

Provide any other information that would aid the Piercing Studio in your healing process evaluation.

I acknowledge that I have been given adequate opportunity to read and understand this document, that it was not presented to me at the last minute, and grasp that I am signing a legal contract waiving certain rights to recover damages against the Piercing Studio.

I confirm that the information I provided in this document is accurate and true.

If any provision, section, subsection, clause or phrase of this release is found to be unenforceable or invalid, that portion shall be severed from this contract. The remainder of this contract will then be construed as though the unenforceable portion had never been contained in this document.

I hereby declare that I am of legal age (and have provided valid proof of age and identification) and am competent to sign this Agreement.

I HAVE READ THE AGREEMENT, I UNDERSTAND IT, AND I AGREE TO BE BOUND BY IT.

Signed Date

Date

Client Signature

Full Name*

First NameLast Name

Date of Birth*

Date

Current Phone Number*

Area CodePhone Number

Email*

example@example.com

Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Type of Piercing Requested*

Date of Piercing Procedure*

Date

Piercing Consent Form

Pre-Procedure Questionnaire

Acknowledgment and Waiver

Client Information