INDE Minor Body Piercing Consent Form

INDE Youth Piercing Consent Form
I voluntarily give my full consent to body piercings carried out by INDE. 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.
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.This procedure involves puncturing the skin with a sterile hollow needle and inserting body jewelry.Hollow needle piercing carries inherent risks including pain, swelling, bleeding, infection, allergic reaction, nerve damage, and scarring.Proper aftercare is essential to minimize the risk of complications. I have received and understand the aftercare instructions provided.The jewelry used is titanium medical grade, suitable for initial piercings, and I have approved the jewelry selection.I am not under the influence of alcohol, drugs, or any mind-altering substances.The piercer has explained the process, risks, and answered all my questions to my satisfaction.I have received and understand the aftercare instructions provided.
Client Information
Parent / Guardian Full Name*

First NameLast Name
Minor Client Name*

First NameLast Name
Minor Date of Birth*

MonthDayYear
Date
Parent / Guardian Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Parent / Guardian Email*
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
AnxietyEczamaEpilepsyHaemophiliaHeart ConditionHIVInk AllergyLatex AllergyNickel AllergyPregnancyTuberculosisHemophilia or bleeding disorderDiabetesSeizure DisorderSkin Condition or AllergiesCurrently taking blood thinners or antibioticsNONE APPLYOther
Client gives permission for before-and-after photos to be taken and used for marketing and educational purposes. Identifiable features will be cropped or blurred unless written permission is provided.Client does not give permission
Client releases the Provider from any liability for adverse reactions, injuries, or dissatisfaction resulting from the service. The Client acknowledges that services are provided at their own risk.
Client confirms that they have disclosed any relevant medical conditions, allergies, or skin sensitivities prior to receiving services. The Provider will not be held liable for any undisclosed conditions or reactions resulting from the services rendered.
Client agrees to abide by all scheduling, cancellation, deposit, and no-show policies as outlined on the Provider’s website or communicated directly prior to booking. Client understands that deposits may be non-refundable and fees may apply for late cancellations or missed appointments.
Client consents to receive services from the Provider and understands that results may vary depending on individual skin types, healing processes, and aftercare. The Client has had the opportunity to ask questions regarding the procedures and has received satisfactory answers.
CLEANING INSTRUCTIONS

First 24 hours-use a warm compress and ibuprofen to relieve any swelling.

Clean 2x a day (morning & night) for the first 4–8 weeks using the following method:

-Wash your hands thoroughly before touching your piercing.
-Use hydrochlorous spray that is provided.
-Let it air dry — do not use cotton balls, alcohol, or peroxide.

WHAT TO AVOID

-No touching or twisting the jewelry
-Avoid sleeping on the piercing (use an airplane pillow) sleeping or any trauma to the piercing can cause piercing bumps and migration.
-No submerging in pools, lakes, hot tubs for at least 4 weeks
-Avoid makeup, lotion, or hair products near the area
-Do not remove jewelry during healing — this may cause the hole to close
-Do not use harsh cleansers, soaps, or essential oils on the area

HEALING TIME ESTIMATES

Ear lobes: 6+ Months
Cartilage: 12+ months
Nose: 3–6 months

JEWELRY CARE

-Your initial jewelry is titanium medical grade and safe for healing.
-Do not change or remove jewelry for at least 8–12 weeks, or until fully healed.
-If you must change it, return to the studio or consult a professional piercer.

CONTACT US IF YOU NOTICE:

Persistent swelling, redness, or heat
Yellow or green discharge with odor
Sharp pain, bumps, or signs of embedded jewelry
I, the undersigned, am the parent or guardian of the minor listed above. I consent to the body piercing described above being performed at this facility. I acknowledge that:

I have been informed of the nature of the procedure, risks, and possible complications.
I understand aftercare instructions will be provided.
I affirm that my child is voluntarily requesting this procedure.
I release the piercer and studio from any liability related to the procedure.
Consent and Acknowledgement as the Legal Guardian / Parent consent if under 18*

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• I release the piercer and studio from any liability for any complications or issues arising from this piercing, including infection, migration, or rejection due to personal aftercare, lifestyle, or body chemistry. • I understand INDE is not liable if I fail to follow aftercare instructions or choose to remove the jewelry prematurely.
Signed Date*

MonthDayYear
Date
Please upload a photo of your valid driver's license ID:*

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Please upload a photo of minors birth certificate:*

Cancelof
Should be Empty:

INDE Youth Piercing Consent Form

Client Information