Initial* I (Parent/Guardian) confirm that the (Minor) is NOT pregnant or nursing. If (Minor) has any condition that might effect the healing process of the selected piercing, I (Parent/Guardian) will inform the Piercer.
Initial* I (Parent/Guardian) confirm that (Minor) does NOT suffer from medical conditions such as, but not limited to: keloid or hypertrophic scarring, psoriasis at the site of piercing or any open wound or lesions at the site of piercing.
Initial* Parent/Guardian of Minor has advised the Piercer of any allergies to metals, latex gloves, soaps and medications. I (Parent/Guardian) acknowledge it is not reasonably possible for the Piercer to determine whether (Minor) might have an allergic reaction to the piercing or processes involved in the piercing and further acknowledge that such reaction is possible.
Initial* i I (Parent/Guardian) acknowledge that (Minor) is not under the influence of drugs or alcohol. To my knowledge, the Minor does not have any physical, mental or medical impairment or disability which might affect their well-being as a direct or indirect result of their decision to have a piercing done at this time.
Initial* I (Parent/Guardian) acknowledge that by (Minor) obtaining this piercing will result in a permanent change of 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.
Initial* I (Parent/Guardian) acknowledge that infection is always possible as a result of obtaining a piercing. I (Parent/Guardian) have received aftercare instructions from the Piercer and agree to follow all of them while (Minors') piercing is healing,
Initial* I (Parent/Guardian) understand that (Minor) will be pierced using appropriate instruments and sterilization
I (Parent/Guardian) have read and understand the above information. By signing below, I acknowledge that I consent to the piercing procedure selected above and release Halo Grace Piercing Co. & Piercer from any and all liability from this procedure