Piercing Waiver

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Piercing Waiver

Waiver for Piercing Service at MY Ink Tattoo Studio

Full Name *

Address *

Street, city, province/state, country

Phone *

Email *

Birth Date *

YYYY

Appointment Date *

YYYY

Piercer Name *

Medical Conditions

Please list any and all relevant medical conditions

I acknowledge by signing this agreement that I have been given the full opportunity to ask any and all questions which I might have about the obtaining of a piercing and that all of my questions have been answered to my full satisfaction. I specifically acknowledge I have been advised of the facts and matters set forth below and I agree as follows: *

I am not pregnant or nursing. I do not have epilepsy or hemophilia. I do not suffer from any heart conditions or take medication which thins the blood. I have informed my piercer of any condition such as diabetes that might hamper the healing of the piercing. If I suffer from hepatitis, or any other communicable disease, I have informed the piercer of this fact and I have been advised of any procedures necessary to promote the satisfactory healing of my piercing.

I do not have medical or skin conditions such as but not limited to: acne, scarring (Keloid), Eczema, psoriasis at the site of the piercing, rash, infection, lesion, or any open wounds at the site of the piercing. If I have any type of infection, rash, or lesion anywhere on my body, I will advise my piercer.

I have advised the piercer of any allergies to metals, latex, 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 a reaction is possible.

I acknowledge that infection is always possible as a result of the obtaining of a piercing, particularly in the event that I do not take proper care of my piercing during the healing process. I agree to follow all aftercare instructions while my piercing is healing.

I understand that the piercing deposit is non-refundable and I must give at least 48 hours notice to reschedule or change my appointment, and that I must be on time for my appointment or I will be required to purchase a new deposit.

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 restore the skin involved in this piercing to is pre-piercing condition.

I understand that a microdermal (single point piercing) consists of a pierced point of entry but not a point of exit. Specially designed jewelry is inserted into the pierced area and sits below the skin where it becomes anchored.

I acknowledge I am over the age of sixteen (eighteen for genital piercings) and that I have truthfully represented to my piercer that the obtaining of a piercing is by my choice alone. I consent to the procedure of piercing and to any actions or conduct of the representatives and employees of MY Ink Tattoo Studio find reasonably necessary to perform the piercing procedure.

I understand that MY Ink Tattoo Studio reserves all rights to use any photo or video of my piercing and I consent to photo and video being taken during and after my piercing procedure.

I hereby release and forever discharge and hold harmless MY Ink Tattoo Studio, the piercer and all affiliates, owners, managers, and 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 the process of piercing, and at all times while on the premises, to the fullest extent allowed by the law.

I acknowledge that I have read and understand this piercing waiver. I further understand that I am forfeiting substantial rights, including the rights to sue, and that I am submitting this waiver voluntarily. I am not under the influence of alcohol or drugs and to my knowledge, have no mental or medical impairment that would affect my ability to understand this waiver.

Required

How did you find us? *

Parental/ Guardian Consent

I hereby hold harmless all members and affiliates of MY Ink Tattoo Studio and grant permission for my child to receive piercing services.

All of my questions have been answered fully and I will provide both my ID and my child's ID.

Signature *

By typing my first and last name here, I agree to any and all conditions present on this waiver, and I affirm that the above information is true.

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