minor piercing consent form
  • MINOR piercing consent form

    under 18
  • piercing requested

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  • * The MINOR IS NOT pregnant or nursing. If I have any condition that might effect the healing process of the selected piercing, I will inform the Piercer

  • *   The 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, Diabetes, or a Heart Condition

  • *   I have advised the Piercer of any allergies to metals, latex gloves, soaps and 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 reaction is possible.

  • *   I nor the MINOR are 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 well-being as a direct or indirect result of my decision to have a piercing done at this time.

  • *   I acknowledge that (MINOR) obtaining this piercing is by choice alone and 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.

  • *   I understand that infection is a potential risk of body piercing. I have received aftercare instructions from the Piercer and agree to be responsible for ensuring that my minor child follows these instructions during the healing process.

  • *   I understand that the MINOR'S piercing will be performed using appropriate instruments and sterilization methods in accordance with industry standards.

  • I 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 

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