Piercing Consent Form

Piercing Consent Form

Review the consent requirements for Washington and confirm your agreement.
Full Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Are you under 18 years of age?
If you are under 18, please provide parent or legal guardian's full name.

First NameLast Name
Parent or Guardian Phone Number (if under 18)
Please enter a valid phone number.Format: (000) 000-0000.
Payment Amount
Type of Piercing Requested
Please list any allergies, medical conditions, or medications.
Signature (Client or Parent/Guardian if under 18)
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Photo ID

Cancelof
Should be Empty: