BODY PIERCING CONSENT & RELEASE FORM
I First Name* Last Name* acknowledge by signing this release l have been given the full opportunity to Ask any and allquestions which I may have about obtaining a piercing from Jewels Inkpire LLC and all myquestions have been answered to my full and total satisfaction. I acknowledge I have beenadvised of the matters set forth below and I agree as follows:Initial*l am Not, pregnant or nursing. If I have any condition that might affect the healing of thispiercing, I will inform my piercer.Do not suffer from any medical or skin condition such as, but not limited to: Keloid orhypertrophic scarring, psoriasis at the site of piercing or any open wounds or lesions at thesite of the piercing.Initial* I have advised the piercer of any allergies to metal latex gloves, soaps and medications. Iacknowledge it is not reasonably possible for the piercer to determine whether I might havean allergic reaction to the piercing process involved in the piercing and further acknowledgethat such reaction is possibleInitial* I have trustfully presented to the piercer I am over the age of 18 years, or a minor with legal documentation. Initial* I am not under the influence of drugs or alcohol. To my knowledge, I do not have any physical, mental or medical impairment or disability which may affect my well-being as a direct or indirect result of my decision to have a piercing done at this time.Initial* I acknowledge that obtaining a piercing is a choice and it is my choice alone. I have received after care instructions and I agree to follow them as directed throughout my healingprocess.Initial* I acknowledge that this is a Final Sale, there is no refunds for piercings, the piercer has usedsupplies to pierce me that can not be returned.Initial* I understand I will be pierced using appropriate instruments and jewelry which have beensterilized.Therefore I request my piercer to pierce my I understand this type ofpiercing takes or longer to heal. Initial* I agree to forever release and discharge and hold harmless Jewels Inkpire LIC employees from any and all claims, and damages or legalactions arising from or connected in any way with my piercing, or the procedure and conduct used in my piercing.Initial* I have been given verbal and written information about my piercing from my piercer. I am aware of the piercing procedure and understand all risks and possible consequences of body piercing services. Instructions for care and restrictions have been given and I am fully aware. I am also aware of all legal restrictions against minors body piercings.
Body Part Pierced: * Jewelry Used: * Any complications? *