Hollow Needle Piercing Consent Form

Name

DOB

Email

example@example.com

Phone

Emergency Contact

Emergency Contact Number

Please enter a valid phone number.

Piercing/s Receiving

I acknowledge that by signing this consent form I have been given the full opportunity to ask any and all questions which I might have about obtaining a piercing and all my questions have been answered to my full and total satisfaction. I have also read Sun & Sol's Piercing Policies.

Please initial and acknowledge the following:

1. I am not pregnant or nursing.

2. If have any condition that might affect the healing of this piercing, I will inform my piercer.

3. I do not suffer from any 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.

4 I have advised my piercer of any allergies to metals, latex gloves, soaps, lidocaine and medications I acknowledge it is not reasonably possible for my 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.

5. I am 18 years or older or I am signing as the legal guardian of my child

6. I am not under the influence of any drugs or alcohol.

7. 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 receive a piercing at this time.

8. 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 to the ability to later restore the skin involved in this piercing to its pre piercing condition.

I understand there is a long healing process involved in receiving this piercing. I agree to any and all piercing placements before the service is performed and understand that the piercer is not responsible for the healing process afterward. I agree to release and forever discharge and hold harmless the piercer from any and all claims, damages, or legal actions arising from or connected in any way to receiving this piercing, or the procedure and conduct used in my piercing.

Date

Signature

Hollow Needle Piercing

Hollow Needle Piercing (5-17 years old only)