MINOR piercing consent form

Initial* The MINOR IS NOT pregnant or nursing. If the MINOR has any condition that might effect the healing process of the selected piercing, I (parent/guardian) will inform the Piercer.

Initial*   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, Hemophilia, Diabetes, or heart condition.

Initial*  I (parent/guardian) have advised the Piercer of any allergies to metals, latex gloves, disinfectant soaps, pigments, dyes or medications that the MINOR may have. I acknowledge it is not reasonably possible for the Piercer to determine whether the MINOR might have an allergic reaction to the piercing or processes involved in the piercing and further acknowledge that such reaction is possible.

Initial*   I (parent/guardian) nor the MINOR are 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 the MINORS piercing preformed at this time.

Initial*   I (parent/guardian) 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.

Initial*   I (parent/guardian) 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 the MINOR follows these instructions during the healing process.

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