Piercing Consent Form

  • Client Information

  • Date of Birth*
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  • I hereby give consent to Zen Ink, LLC to perform a body piercing, and in consideration of doing so, I hereby release and forever discharge and hold harmless Zen Ink, LLC, the Piercer/Artists and all affiliates, Owners, Managers and Independent Contractors from any and all claims, damages or legal actions arising from or connected in any way with my piercing procedure and conduct used in my performing my piercing, to the fullest extent allowed by the law.*
  • I fully understand that any Independent Contractors of Zen Ink, LLC when performing a body piercing, do not act in the capacity as a medical professional. The suggestions made by any Independent Contractors or agent of Zen Ink, LLC are just suggestions. They are not to be construed as, or substituted for advice from a medical professional. I understand that the body piercing will be performed using appropriate techniques and instruments. I also understand that infections can occur due to lack of proper hygiene and metal sensitivities.To ensure proper healing of my body piercing, I agree to follow the written and verbal aftercare instructions that will be provided, until healing is complete. I understand that a body piercing may take several months to heal properly.*
  • I understand that I am making a modification to my body, and no claims about the possibility of reversing these changes have been made or implied by Zen Ink, LLC or any of its Independent Contractors or agents.*
  • I agree that these waivers also pertain to and are designed to protect any and all establishments of Zen Ink and their Independent Contractors.*
  • I am at least 18 years old.*
  • Do you have a heart condition?*

  • Do you have Diabetes?*

  • Do you have Epilepsy?*

  • Do you suffer from Hemophilia?*

  • Do you have Hepatitis/HIV or any other communicable disease?*

  • Do you have sunburn, discoloration, lumps around the piercing area?*

  • Are you pregnant/breastfeeding?*

  • Have you eaten in the last 5 hours? It's a good idea to eat before hand to increase your blood sugar levels. (If you have not, there is a higher risk for passing out/getting sick, so please ASK us for a snack before we start).*

  • Do you suffer from any condition that makes this procedure dangerous?*

  • Have you consumed drugs/alcohol in the last 8 hours? if so, what and how many?*

  • Have you recently taken: blood thinners, antibiotics, prednisone, accutane?*

  • Are you prone to fainting?*

  • I agree to speak softly and silence my cell phone in order to help keep a calm, spa like environment.*
  • Are you currently sick? In the last 14 days, have you been sick or been in contact with anyone that is sick.*
  • I understand that getting pierced does temporarily stress the body and the immune system, which could make me more susceptible to illness and infection. I accept this risk.*
  • I understand the Zen Ink has put additional protective measures in place in order to reduce the risk of contamination, virus, or pathogen but it is impossible to completely eliminate that risk.*
  • I agree to release and forever hold harmless Zen Ink and its agents and representatives for any and all claims, damages, or legal actions in the event I contract COVID-19 or any other illness after choosing to get pierced.*
  • Have you experienced any symptoms (fever, cough, shortness of breath, chills, body aches, sore throat), had exposure to someone exhibiting COVID-19 symptoms or confirmed illness within the last 14 days?*
  • If being pierced by an apprentice: I acknowledge and I am fully aware that my piercer is an apprentice and still learning. I understand that apprenticeships are a form of on-the-job training where the art of the piercing can be taught, along with techniques for avoiding blood-borne pathogens, handling needles, and studio etiquette. I understand that apprentices are still getting valuable hands-on experience and learning the craft of piercing. I am aware that this piercing apprentice does have valid up to date Blood Borne Pathogen (BBP) training certificate. I understand the risks involved and consent to have a piercing by this piercing apprentice.*
  • I consent to Authorization for Picture of my Piercing to be used on Social Media, Website etc*
  • Are you allergic to any of the following?*

  • How did you hear about us?*

  • Acknowledgment and Waiver

  • Signed Date*
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  • For Minors:

    Parent must be present at time of Piercing. We will also need proof of parenthood at time of piercing. This will be something that says you are the parent/legal guardian. Examples are: Child and parent IDs with matching last names and addresses, Birth Certificate and Parent ID, Court Issued paperwork and ID.

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