Piercing Consent Form

Client Name

First NameLast Name

Date of Birth

Date

Phone Number

Please enter a valid phone number.

Email

example@example.com

Please acknowledge the following items:

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.I understand my ears will be pierced with single-use earrings that are pre-packaged, sealed and sterilized.If I'm taking blood thinning medications or antibiotics, if I have diabetes, if I am pregnant or have a history of infection or any other medical condition, I acknowledge that ear piercing may carry a risk and I must consult a physician for approval before piercing my ears.I understand that ear piercing may contribute to the formation of cyst or keloids.I understand that Jonesy Wood is unable to monitor my at-home aftercare, therefore it is my responsibility to follow aftercare instructions.I have agreed to this ear-piercing procedure and I am fully aware of the potential risks and complications.

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I voluntarily give my full consent to ear piercings carried out by Wood Global Enterprise LLC DBA Jonesy Wood . 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.

Jonesy Wood follows a safe and hygenic ear piercing procedure. However, improper care of newly pierced ears on my behalf or due to other causes can result in problems outside of their control. I, the undersigned, acknowledge that ear piercing carries some risk. These riskinclude but are ot limited to: infection, metal sensitivity, allergic reactio, inflammation, embedded earrings, scarring, fainting and other complications.
I understand that Jonesy Wood ear piercing spacialist, when preforming ear piercing procedures, do not act inthe capacity of medical professionals. The recommendations made by any Jonesy Wood ear piercing specialist are recommendations only. They are not to be construed as, or taken in lieu of, advice from a medical professional.
I voluntarily agree to this ear piercing procedure, for myself or for a minor in my care, and I am fully aware of the potential risk and complications. In addition, I hereby assume all risk of loss or injury of any kind whatsoever that may be associated with this ear piercing procedure.
By signing this EAR PIERCING RELEASE OF LIABILITY AND CLAIM WAIVER, I hereby acknowledge and represent the following:
- I have read and understand the EAR PIERCING RELEASE OF LIABILITY AND CLAIM WAIVER and sign it voluntarily.
- I am atleast 18 years of age and hold myself liable in respect to this ear piercing proceure. I hereby release liability on behalf of Jonesy Wood and their affiliates and waive any future claims against them.
- I understand I must be 18 years of age or older to have my ears pierced and my signature below confirms my acknowledgement. I realize tis applies to first time ear piercings and consecutive ear piercings. I understand I must show proof of age by presenting some form of Identification.
- I am the parent or legal guardian of a minor under the age of 18 and hold myself liable in respect to this ear piercing procedure. I hereby release liability on behalf of Jonesy Wood and their affilliates and waive any future claims against them.
- For purposes of signing this EAR PIERCING RELEASE OF LIABILITY AND CLAIM WAIVER, I understand that it is fraudulent for a minor to represent herself/himself as an adult and/or to falsely represent oneself as a parent or legal guardian.

Please select the conditions you have:

Ear Piercing Aftercare Instructions and Agreement

I understand that I must carefully follow all ear-piercing aftercare instructions and hereby release Jonesy Wood from any claims that I may have as a result of my failure to follow all ear-piercing aftercare instructions.

Signature

Signed Date

Date

Piercing Consent Form

Client Information