Piercing Consent Form

I am not pregnant or nursing

I am not under the influence of any drugs or alcohol

I am over the age of 18 years

If I have any condition that may affect the healing of this piercing, I have informed my piercer.

I do not suffer from medical or skin conditions such as keloid or hypertrophic scarring, psoriasis at the site of the piercing, or any open wounds or lesion at the site of piercing

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

I acknowledge 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 the ability to later restore the skin involved in this piercing to its pre-pierced condition

I acknowledge infection is always possible as a result of obtaining piercing. I have received aftercare instructions and agree to follow them as directed until my piercing is healed

I understand I will be pierced using appropriate instruments and sterilization

I acknowledge by signing this release, I have been given the opportunity to ask any and all questions which I might have about obtaining a piercing from Inkeeper's Tattoo Parlor and all my questions have been answered to my full and total satisfaction. I acknowledge I have been advised of the matters below and I agree as follows:

Therefore, I request the Piercer to pierce my

I understand this type of piercing usually takes __ or longer to heal.

I agree to release and forever discharge and hold harmless the Piercer and all other 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.

Leave us a note or comments we should know about ahead of time.

Name

Age

Address

Phone Number

Driver's License

State

Drivers License Photo

Upload File

Email

Legally Binding Signature

Date