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Body Piercing
Let us do this part
Today's Date:
Mon Apr 29 2024 04:46
Practitioner:*
Piercing:*
Jewellery:*
Total Price:*
Please read and answer
Artists Rights*
The Artist has the right to refuse any client and any piercing. If the client is rude, disrespectful, or abusive, the appointment will be canceled. If the anatomy doesn't accommodate for the desired piercing, The Artist has the right to refuse the piercing. The Artist may also refuse to pierce with jewellery that isn't suitable for the initial healing (seam rings, too thin of a gauge, too small of a diameter). If the client is rude, disrespectful, or abusive, they may be banned from receiving any services, from any Artist at The Studio, at any future time.
 
How did you hear about us?
How did you hear about us?
 
Y
N
Eaten*
Have you eaten in the past 4hrs? It's a good idea to before hand to increase your blood sugar levels.
Y
N
Fainting*
I AM NOT PRONE TO FAINTING.
Details:
 
Y
N
Bloodbourne Pathogens*
Do you have any bloodbourne pathogens, transmittable diseases or recent illnesses? (It's okay if you do; we just want to know for ours and other's safety).
Details:
 
Y
N
Medical Conditions*
I affirm that I do not have diabetes, epilepsy, hemophilia, nor do I have a heart condition or take blood thinning medication. I do not have any other medical or skin condition that may interfere with the procedure or healing of the piercing. I am not the recipient of an organ or bone marrow transplant or, if I am, I have taken the prescribed preventive regimen of anti-biotics that is required by my doctor in advance of any invasive procedure such as piercing. I am NOT PREGNANT or nursing.
Details:
 
Risks*
That I have been fully informed of the risks associated with getting a piercing. I understand that these risks, known and unknown, can lead to injury, including but not limited to infection, scarring and keloiding and allergic reactions. Having been informed of the potential risks associated with getting a piercing, I still wish to proceed with the piercing and I freely accept all risks that may arise from piercing.
Release*
TO WAIVE AND RELEASE to the fullest extent permitted by law each of The Artist and The Studio from all liability whatsoever, for any and all claims or causes of action that I, my estate, heirs, executors, or assigns may have for personal injury or otherwise, including any direct and/or consequential damages, which result or arise, whether caused by the negligence or fault of either The Artist or The Studio or otherwise.
Questions*
That both The Artist and The Studio have given me the full opportunity to ask any and all questions about the piercing procedure and they have been answered to my total satisfaction.

Questions can be asked at any time before the procedure, so feel free to ask when in the piercing room if anything comes up after this form is already filled out.
Aftercare*
I affirm that I have been given the instructions on the care of my piercing while it's healing and I understand and will follow them. I acknowledge that it is possible that the piercing can become infected; particularly if I do not follow the instructions.
Duress*
I affirm that I am not under the influence of alcohol or drugs, and I am voluntarily getting a piercing without duress.
Permanent change*
I acknowledge that the piercing will result in a permanent change to my appearance and that my skin may not be restored to its pre-piercing condition even after its removal, even with dermatological treatments.
This Document*
I acknowledge that I have been given adequate opportunity to read and understand this document, that it was not presented to me at the last minute, and I understand that I am signing a legal contract.
Attorney Fees*
I agree to reimburse each of The Artist and The Studio for any attorneys fees and costs incurred in any legal action I bring against either The Artist or The Studio and in which either The Artist or The Studio is the prevailing party. I agree that the courts of Ontario in Canada shall have personal jurisdiction and venue over me and shall have exclusive jurisdiction for the purpose of litigating any dispute arising out of or related to this agreement.
Photography*
I release all rights to any photographs taken of me and the piercing and give consent in advance to their reproduction in print or electronic form.
Y
N
COVID SCREENING*
Do you have any of the following new or worsening symptoms or signs? Symptoms should not be chronic or related to other known causes or conditions.

Fever or chills
Difficulty breathing or shortness of breath
Cough
Sore throat, trouble swallowing
Runny nose / stuffy or nasal congestion
Decrease or loss of smell or taste
Nausea, vomiting, diarrhea, abdominal pain
Y
N
COVID SCREENING*
Have you travelled outside of Canada in the part 14 days?
Have you had close contact with a confirmed or probable case of COVID-19?
Results of Covid Screening Questions:
• If the individual answers NO any covid-19 questions they have passed and can enter the workplace.
• If the individual answers YES to any Covid-19 questions they have not passed and should be advised that they should not enter the workplace (including any outdoor, or partially outdoor, workplaces).
They should go home to self-isolate immediately and contact their health care provider or Telehealth Ontario (1 866-797-0000)to find out if they need a COVID-19 test.
If any provision, section, subsection, clause or phrase of this release is found to be unenforceable or invalid, that portion shall be severed from this contract. The remainder of this contract will then be construed as though the unenforceable portion had never been contained in this document.
Client Information
I hereby declare that I am of legal age (with valid proof of age) and am competent to sign this Agreement or, if not, that my parent or legal guardian shall sign on my behalf, and that my parent or legal guardian is in complete understanding and concurrence with this agreement.
Legal Name:*
Pronoun:
Chosen name:
Address:*
Date of birth:*
If you are under 16 your parent/guardian will be required
Phone #:*
Email:*
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Signature:*


Photo ID*
Please take photo(s) of your government issued photo IDs and related paperwork.