Piercing Waiver

In consideration of receiving a piercing from: *

at Pushing Inc. Tattoo Emporium (together with its employees, apprentices and agents, the “Tattoo Studio”), I agree to the following:{typeA84}

That I, full name* field. (clearly PRINT your name) have been fully informed of the inherent risks, associated with getting a piercing. I fully understand that these risks, known and unknown can lead to injury, including but not limited to infection, scarring, difficulties in detecting melanoma and allergic reactions to jewelry, latex gloves, gloves, soap, cleansers, ointments and/or any other product used prior, during or after the piercing procedure. Having been informed of the potential risks associated with getting a piercing, I still wish to proceed with the piercing procedure and I freely accept and expressly assume any and all risks that may arise from piercing.

TO WAIVE AND RELEASE to the fullest extent permitted by law each of the Artist, Piercer and all affiliates, Owners, Managers and Employees and the Tattoo Studio from all liability whatsoever, for any and all claims or causes of action that I, my estate, heirs, executors or assigns may have for personal injury or otherwise, including any direct and/or consequential damages, which result or arise from the application of my piercing, whether caused by the negligence or fault of either the Artist or the Tattoo Studio, or otherwise.*

That both the Artist and the Tattoo Studio have given me the full opportunity to ask any and all questions about the application of my piercing and all of my questions have been answered to my total satisfaction.*

The Artist and the Tattoo Studio have given me verbally and written aftercare instructions on how to care for my piercing while it’s healing, and I understand them and will follow them. I acknowledge that it is possible that the piercing can become infected, particularly if I do not follow the instructions given to me. If any damage or irritation occurs to my piercing due to my own negligence, I agree that any work done to assist with said irritation will be done at my own expense*

Variations in jewelry may exist for the piercing I have selected and the actual piercing when it is inserted into my body. I also understand that over time, my piercing may change in appearance due to irritation, jewelry, or migration. I understand that certain reactions to aftercare products or jewelry may occur and I agree it is at my own responsibility to seek assistance from the Tattoo Studio*

Neither the Artist nor the Tattoo Studio is responsible for the loss of jewelry, closing of any piercing, or irritation due to jewelry from outside sources and I understand any work done to assist with any of the above will be at my own expense.*

If I have diabetes, epilepsy, hepatitis, hemophilia, HIV-AIDS, or any other communicable disease, heart condition or take medicine which thins the blood I have consulted and gained the approval from my doctor prior to having a piercing procedure done and I have advised my piercer. I do not have any other medical or skin conditions such as but not limited to: acne, scarring (Keloid), Eczema, psoriasis, rash, infection, lesion, freckles, moles or sunburn in the area to be pierced that may interfere with the application or healing of the piercing. If I have any type of infection, rash, or lesion anywhere on my body, I will advise my piercer. I am not the recipient of an organ or bone marrow transplant or, if I am, I have taken the prescribed preventive regimen of anti-biotics that is required by my doctor in advance of any invasive procedure such as tattooing or piercing. I am not pregnant or nursing. I do not have a mental impairment that may affect my judgment in getting the piercing.*

I am not under the influence of alcohol or drugs, and I am voluntarily submitting to be pierced by the Artist without duress or coercion and of Sound body and Mind*

I understand that while a piercing may be a semi-permanent change to my appearance that may be removed, I understand that there may be scarring, a marking, or permanent disfigurement left behind and my Piercer and the Tattoo Studio are not held responsible*

I acknowledge that I have been given adequate opportunity to read and understand this document, that it was not presented to me at the last minute, and I understand that I am signing a legal contract waiving certain rights to recover against the Artist and the Tattoo Studio.*

I release all rights to any photographs taken of me and the piercing and give consent in advance to their reproduction in print or electronic form. (If you do not initial this provision, please advise and remind your Artist and the Tattoo Studio NOT to take any pictures of you and your completed and/or healed piercing*

The anatomy of my body may be completely different to the anatomy of every other person. Piercing sites highly at risk of contact or stress due to daily activity (eg. nipple, navel, nostril, upper helix etc.) could cause added risk of irritation, migration, and sometimes disfigurement. I understand that the Artist and the Tattoo Studio are not responsible for any and all alterations to the piercing due to my anatomy or high risk behaviour.*

I agree to reimburse each of the Artist and the Tattoo Studio for any attorneys’ fees and costs incurred in any legal action I bring against either the Artist or the Tattoo Studio and in which either the Artist or the Tattoo Studio is the prevailing party. I agree that the courts of ONTARIO in CANADA shall have personal jurisdiction and venue over me and shall have exclusive jurisdiction for the purpose of litigating any dispute arising out of or related to this agreement. Through the document, the piercer will be referenced to as “Piercer” or “Artist”.*

I have witnessed all sterile packages opened in front of me. Sterilization has been explained to me and all of my questions have been answered to my total satisfaction. The sharps (needles) were disposed of in the sharps disposal in front of me.*

I understand that service can be refused if I do not agree to all terms and conditions, with the exception of photographs.*

Please check the following if they apply to you:

Alcohol in the past 24 hoursPain relieversProne to faintingEaten in the past 2 hours

If any provision, section, subsection, clause or phrase of this release is found to be unenforceable or invalid, that portion shall be severed from this contract. The remainder of this contract will then be construed as though the unenforceable portion had never been contained in this document.

I hereby declare that I am of legal age (and have provided valid proof of age) and am competent to sign this Agreement or, if not, that my parent or legal guardian shall sign on my behalf, and that my parent or legal guardian is in complete understanding and concurrence with this agreement

I HAVE READ THIS AGREEMENT, I UNDERSTAND IT, I AGREE TO BE BOUND BY IT.

First Name*

Last Name*

Date of Birth*

MonthDayYear

Email*

Confirmation Emailexample@example.com

Phone Number*

Please enter a valid phone number.

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Signature*

Current Date

Date

Signature of Parent or Guardian and by their signature they, on my behalf, release all claims that both they and I have.

Current Date

Date

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Piercing Waiver

THIS DOCUMENT IS THREE PAGES [Or Two, Two Sided]. PLEASE BE ADVISED THAT AFTER READING PROVISIONS THEN CLICKING AGEE IS EQUIVALENT TO INITIAL EACH PROVISION AND WILL SHOW THAT YOU UNDERSTAND EACH PROVISION.