(MINOR) BODY PIERCING CONSENT FORM

GOOD PAIN ARTWORKS • 112 NE 4th St., Grand Prairie, TX, 75050 • (214) 518-6235
CLIENT INFORMATION

All information provided below is confidential & for professional use only.
CLIENT NAME

First NameLast Name
AGE
Must provide Original Birth Certificate & Photo ID with full name
DATE OF BIRTH

MonthDayYear
2 digit month, 2 digit day, 4 digit yearMM-DD-YYYY
TYPE OF IDENTIFICATION PROVIDED:
PHONE NUMBER
Format: (000) 000-0000.
EMAIL
example@example.com
ADDRESS

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
OPT IN TO RECEIVE MARKETING TEXTS/ EMAILS FROM GOOD PAIN ARTWORKS?
ACKNOWLEDGEMENT & WAIVER
I acknowledge by signing this Release I have been given the full opportunity to ask any and all questions which I might have about obtaining a piercing from Amanda Musgrave (hereinafter known as the “Piercer”) and all my questions have been answered to my full and total satisfaction. In consideration of receiving a body piercing from Good Pain Artworks including its artists, associates, apprentices, agents, or any employees (hereinafter referred to as the "Tattoo Studio"). I acknowledge I have been advised of the matters set forth below and I agree as follows:
I have been fully informed of the inherent risks associated with getting a body piercing. Therefore, I fully understand that these risks, known and unknown, can lead to injury including but not limited to: infection, discomfort or pain, scarring, nerve damage, increased risk for adolescents during certain stages of development, bleeding and swelling. Having been informed of the potential risks associated with getting a body piercing, I wish to proceed with the piercing procedure and application and freely accept and expressly assume any and all risks that may arise from piercing.
I WAIVE AND RELEASE to the fullest extent permitted by law any person of the Tattoo 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 procedure and application of my tattoo, whether caused by the negligence or fault of either the Tattoo Studio, or otherwise.
The Tattoo Studio has given me written instructions on the care of my body piercing while it's healing. I have read and understand these aftercare instructions, and will follow them. I acknowledge that it is possible that the body piercing can become infected, particularly if I do not follow the instructions given to me. If any re-piercing is needed due to my own negligence, I agree that the procedure will be done at my own expense.
I have trustfully represented to the Piercer all the necessary documents for minor body piercing. My parent has brought me into the Tattoo Studio as required by Texas Code. 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 am voluntarily submitting to be pierced by the Piercer without duress or coercion.
I agree to reimburse the Tattoo Studio for any attorneys' fees and costs incurred in any legal action I bring against the Tattoo Studio and in which either the Artist or Piercer of the Tattoo Studio is the prevailing party. I agree that the courts of located in the County of Dallas within the State of Texas 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.
Therefore, I request the Piercer to pierce my
I understand this type of piercing usually takes ______________________ or longer to heal.
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.
DATE OF APPOINTMENT

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
SIGNED DATE

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
CLIENT SIGNATURE
PIERCER SECTION

To be completed by the Piercer/ Shop Manager ONLY
PIERCER NAME
LOCATION OF PIERCING
NEEDLE/ JEWELRY USED
Should be Empty:

CLIENT INFORMATION

ACKNOWLEDGEMENT & WAIVER

PIERCER SECTION