Piercing Consent Form

Please knowledge these following terms.

I do not have any symptoms of COVID-19 and I accept to follow the rules of Hope's space 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 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 alcoholI understand that the procedure causes a permanent change to my skin and bodyI 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.Understand and consent to a voluntary piercing done by a non-licensed piercer and understand the risks of receiving the piercing.

Do you have any medical conditions that I need to know about prior to this apt? Such as, POTS, Anemia, Low iron, Allergies, Diabetes.

Are you pregnant or planning to be?

YesNo

Do you have any of the following? Hepatitis B (HBV), Hepatitis C (HCV), and HIV (AIDS)

YesNo

Type of Service

Customer's Name

First NameLast Name

Phone Number

Format: (000) 000-0000.

Email Address

example@example.com

Date of Birth

Date

By signing below, you confirm that you have provided accurate and current information on this form. I affirm that I have made this consent and waiver voluntarily. In any case that I decide to withdraw or revoke my waiver, I may do so by submitting a written request signed by me to Hope.

Customer's Signature

Date Signed

Date

Please submit any type of proof of ID. ( Drivers licenses, State ID, Permit, Birth Certificate, or School ID. ) *