Consent and Waiver for Piercing

Consent and Waiver for Piercing

Upon signing this form, I accept that I have been given the opportunity to ask questions concerning the piercing process, (Herein referred to as body modification). Its costs, possible risks, and aftercare that I accept these questions were asked fully and to my satisfaction.
Full Name*

First NameLast Name
Pronouns
Phone Number*
Please enter a valid phone number.
Piercer Name
Email Address*
example@example.com
I agree to receive marketing emails from Mister Finster's*

YesNo
Home Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Are you currently taking any blood thinning medications, or medications that effect the skin or healing?*

YesNo
I am not pregnant or nursing.*

Agree
I have let my piercer know of any conditions medical or not that may affect the piercing and healing process as well as conditions such as keloid, hypertrophic scarring, psoriasis at the site of the piercing, or any open wounds or lesions at the site of the piercing.*

Agree
I have advised the piercer of any allergies to metals, latex, soaps or medications. I acknowledge it is not reasonably possible for the piercer to determine whether I might have an allergic reaction to the piercing or processes involved in the piercing and further acknowledge that such a reaction is possible.*

Agree
I am either at least 18 years of age and signing for myself, or I am signing on behalf of a minor of whom I am a legal guardian.*

Agree
I am not under the influence of drugs or alcohol. To my knowledge, I do not have any physical, mental or medical impairment or disability which might affect my wellbeing as a direct or indirect result of my decision making in getting this procedure done.*

Agree
I acknowledge that obtaining this piercing is my choice alone and will result in a permanent change to my 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.*

Agree
I acknowledge infection is always possible as a result of obtaining a piercing. I have received aftercare instructions and agree to follow them.*

Agree
I understand I will be pierced using appropriate instruments and sterilization.*

Agree
I request the piercer to pierce my body part (ex earlobe)*. I understand this type of piercing usually takes longer to heal.
I agree to release and forever discharge and hold harmless the piercer and all employees from any and all claims, damages or legal actions arising from or connected in any way with my piercing, or the procedure and conduct used in my piercing.*

Agree
Client Signature (Please sign below)*

Clear
Should be Empty: