Drop Piercing Consent Form

ATTENTION PARENTS- It's our policy that we do not, under any circumstances allow you to hold your child down during the piercing procedure. It's also our policy that we will not pierce your child if they are visibly not ready to be pierced. Please make sure that your child understands and is fully ready to be pierced before proceeding, thank you for understanding!

Which Drop Piercing location are you visiting today?*

We're so glad you're here! How did you hear about us? Please select one*

I acknowledge by signing this release that I have been given the full opportunity to ask any and all questions which I might have about obtaining a piercing from Drop Piercing LLC (hereinafter known as the "Piercer") and all my questions have been answered to my full and total satisfaction. I acknowledge I have been advised of the matters set forth below and I agree as follows:

I am not pregnant. If I have any condition that might affect the healing of this piercing, I will inform my Piercer.*

I agree to this statement

I do not suffer from medical or skin conditions such as but not limited to: keloid or hypertrophic scarring, psoriasis at the site of the piercing or any open wounds or lesions at the site of the piercing.*

I agree to this statement

I have advised the Piercer of any allergies to metals, latex gloves, providone-iodine, soaps and medications. I acknowledge it is not reasonably possible for the Piercer to determine whether I might have an allergic reaction to the piercing or process involved in the piercing and further acknowledge that such a reaction is possible.*

I agree to this statement

I am over the age of 18 years. 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 might affect my well-being as a direct or indirect result of my decision to have a piercing done at this time.*

I agree to this statement

I acknowledge that obtaining this piercing is my choice alone and will result in a permanent change to my appearance, and that no representation has been made to me as the ability to later restore the skin involved in this piercing to its pre-piercing condition.*

I agree to this statement

I acknowledge infection is always possible as a result of obtaining a piercing. I have received aftercare instructions and I agree to follow all of them while my piercing is healing.*

I agree to this statement

I understand I will be pierced using appropriate instruments and sterilization.*

I agree to this statement

I hereby grant to Piercer and persons acting for or through it, the right to use, reproduce, assign, and/or distribute images, photographs and video/sound recordings of myself and the minor/child for such uses desired by Piercer for promotional purposes, such as uploading photos on a website and social media platforms.*

I agree to this statement

Therefore, I request the Piercer to pierce: In ear or nostril. I understand this type of piercing usually takes up to 2 months or longer to heal. As a material inducement for Piercer to pierce ears or nostrils (“Piercing Process”), on behalf of myself and the minor/child, and on behalf of our heirs, executors, insurers, administrators and next of kin, I hereby waive, release, covenant not to sue and forever discharge Piercer from any and all liabilities, claims, actions, damages, costs, or expenses of any nature, including those not otherwise limited by Idaho law, arising out of or in any way connected with my piercing, or the procedure and conduct used in my piercing. I further agree that the released claims include any subrogation or other claims asserted by any insurers of myself and the minor/child.

I hereby agree to assume all of the risks on behalf of myself and minor/child and further agree to accept personal responsibility for any personal injury, illness, disability, property damage, economic loss, or any other loss or harm that myself or the minor/child may suffer arising out of or in connection with participation in the Piercing Process.

Any legal disputes or actions arising out of or related to this Consent Form shall be commenced exclusively in a court of competent jurisdiction located in the State of Idaho and shall be governed by the laws of the State of Idaho. If any provision of this Consent Form is ruled to be invalid or illegal, such ruling shall have no effect upon the remaining provisions which shall be considered legally binding and given full effect.

Are you signing for a minor?*

YES (You'll fill out their name below)I'M SIGNING FOR MYSELF

Your Name*

First NameLast Name

Name of Minor (only fill out if signing for a minor)

First NameLast Name

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Signature*

Date*

Date