Adult Piercing Consent Form

Adult Piercing Consent Form

I am signing this form prior to my piercing appointment and I am accompanied by an adult if I am under the age of 18.
Please Read Form & Mark that you have Read & Acknowledge Each Section.

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 Camaria Johnson (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 or Have a Medical Condition that would be affected by this piercing.*

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

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.
Allergies*

I have advised the Piercer of any allergies to metals, latex gloves, 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 processes involved in the piercing and further acknowledge that such a reaction is possible.
I am over the age of 18.*

I have trustfully represented to the Piercer 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.
Permanent Change Acknowledgement*

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 the Risk of Infection.*

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.
Proper Instruments and Sterilization during Piercing.*

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

I authorize and grant the Piercer all rights to take photos and videos regarding my experiences with them. I grant The Piercer all rights to use my photos on Facebook, Twitter, Instagram, and other social media platform. I allow The Piercer to edit, alter, copy, or distribute the photos and videos for social media advertising and marketing. I agree that the photos belong to The Piercer. I understand that I will not receive any monetary compensation.
Personal Data relating service and products.*

I consent to allow the Piercer to use personal data that had/has been provided to The Piercer for the purpose of providing marketing and/or promotional information relating to existing or future products and/or services by any and all delivery methods.
Therefore, I request the Piercer to pierce the following:*

Single LobeSingle CartilageDouble LobeDouble CartilageFlatConchTragusAdvanced DaithRookForward HelixNoseBaby/Toddler Piercing 3month-3 yearChildren Piercing 4-12 years of age
Healing Process*

I understand this type of piercing usually takes up to a month or longer to heal. I garret release and forever discharge and hold harmless the Piercer and all employees from any and all claims, damages or legal actions arising from or connected in any way with my piercing, or the procedure and conduct used in my piercing.
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Adult Piercing Consent Form

Please Read Form & Mark that you have Read & Acknowledge Each Section.