Piercing Consent Form

Piercing Consent Form
I voluntarily give my full consent to body piercings carried out by the practitioner. I am informed about possible side effects and complications of body piercing procedures such as infection and swelling. I understand and agree that it is my responsibility to read and follow the instructions about procedures and aftercare.

I confirm that the information that I provide in this consent form is complete and accurate.
Please acknowledge the following items:

I do not have symptoms of COVID-19 and accept to follow the rules of the shop during my appointment.I have not contacted to anyone who may have symptoms of COVID-19 or get infected by the virus within 14 days.I understand that I am responsible for the any touch-up work due to my fault, negligence or carelessness.I understand that there is a possibility to get an infection if I will not follow the instructions.I accept that having a piercing services is my voluntary choice.I inform that I am not under the influence of drugs or alcohol.I understand that the procedure causes a permanent change to my skin and body.I do not have any mental or medical disability that may affect my wellbeing as a result of having piercing procedure.I release the shop, its administrators, practitioners, stakeholders and workers from any and all of the claims, expenses, liabilities and damages.
Client Information
Client Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Please select the conditions you have:

AnxietyEczamaEpilepsyHaemophiliaHeart ConditionHIVInk AllergyLatex AllergyNickel AllergyPregnancyTuberculosisOther
Fill Out If Minor (Under 17)

Parent Information
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I am the natural parent or legal guardian of Name of Minor Child field. I consent to the body piercing of this minor as follows Location/Piercing

I have legal authority to give consent to the body piercing of this minor. Yes
Signature

Clear
Signed Date

MonthDayYear
Date
Picture of ID

Cancelof
Birth Certificate (Minor)

Cancelof
Should be Empty:

Piercing Consent Form

Client Information

Fill Out If Minor (Under 17)