Piercing Consent Form
ULTIMATE INC STUDIO 123 BROADWAY, TREFOREST, PONTYPRIDD, RCT, CF37 1BE 01443 401222
CLIENT NAME
*
First Name
Last Name
LEGAL GUARDIAN NAME (if under 16 years of age)
First Name
Last Name
Address
*
Street Address
Street Address Line 2
Town
County
Post code
Phone Number
*
Please enter a valid phone number.
do you have any medical conditions that this studio must be made aware of? if so please list below.
CONSENT
*
I understand that a piercing procedure can make a permanent change to my skin and body.I am aware that CCTV is used throughout the studio with recording of video and audio for the purpose of crime prevention and client safety.i am aware that if requested for intermit piercings a privacy screen will be supplied. I consent that if any photographs are taken of me may be used by this studio for advertising on social media , website, studio portfolio etc. I agree that the studio does not have a way of identifying if I am allergic to the elements or ingredients that will be used for my piercing and give full consent of being treated at my own risk. I am aware that it is my sole responsibility to take care of my piercing and I am fully aware of how do do so, the aftercare procedure has been full explained to me at the time of piercing and an aftercare instruction sheet is supplied to myself by the studio.i will not hold the studio responsible for my negligence in looking after my piercing. therefore I indemnify and hold harmless this studio and all employees against any claims, expenses, damages and liabilities.
I the client (or legal guardian consenting on behalf of the child) are of the legal age for the required piercing and the information I have provided in this document is accurate and true.
UNDER 16 YEARS OF AGE LEGAL GUARDIAN MUST UPLOAD PHOTO ID HERE - (OR IF YOU ARE LUCKY ENOUGH TO LOOK YOUNGER THAN YOU ARE THEN WE REQUESTED UPLOAD PHOTO ID BELOW)
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