Liquid Amber Pop Up Piercing

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Let us do this part

Today's Date:

Thu May 1 2025 04:08

Please read and answer

Eaten*

Have you eaten in the past 4hrs? It's a good idea to before hand to increase your blood sugar levels.

Blood Borne Pathogens

Do you have any bloodbourne pathogens, transmittable diseases or recent illnesses? (It's okay if you do, we just want to know for our and other's safety).

Risks*

I, the undersigned, acknowledge that I have been informed of the potential risks involved with body piercing, including but not limited to: infection, scarring, allergic reaction to jewelry or materials. prolonged healing. I agree to follow the aftercare instructions provided to minimize these risks. I understand that failure to follow proper aftercare may result in complications.

Guests*

While a brief stay in the waiting area is possible for a guest, it's crucial to emphasize that this area is primarily designated for client-artist consultations and provides a space for necessary breaks. Please refrain from bringing guests unless absolutely necessary.

Questions & Aftercare*

Both the Piercer and Liquid Amber Tattoo have given me the full opportunity to ask any and all questions about the application of my piercing. PLEASE NOTE: You will have time on the day of your appointment to go over any additional questions

Aftercare*

The Piercer and Liquid Amber Tattoo have given me instructions on how to care for my piercing while it’s healing. I understand these instructions and will do my very best to follow them. I acknowledge that it is possible that the piercing can become infected, particularly if I do not follow the instructions given to me.

Drugs & Alcohol*

During my piercing session, I will not be under the influence of alcohol or drugs, and I am voluntarily submitting to be pierced by the Piercer without duress or coercion.

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 antibiotics that is required by my doctor in advance of any invasive procedure such as piercing. I am not pregnant or nursing.

Health Conditions

Please lists any of the following conditions that apply to you and/or elaborate further.

Extracurricular *

I understand that there are certain activities that are advised against while my piercing is healing. These include, but are not limited to, swimming (lake,oceans, hot tub, pools), exercise that causes excessive sweating or friction to the piercing site etc. Oral and adult piercings have additional advisories which I can discuss with my piercer. I agree to ask my piercer about any concerns regarding extracurricular activities prior to receiving my piercing.

Photos*

I release all rights to any photographs taken of me and the piercer and give consent in advance to their reproduction in print or electronic form. Please note: If you check no on this provision, please advise and remind your piercer and Liquid Amber Tattoo staff to not to take any pictures of you and your fresh piercing.

Liability *

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.

If legal age is required for the certain service I am getting, I hereby declare that I am of legal age (and have provided or will provide valid proof of age on the day of my service) and am competent to sign this Agreement.

Claims*

I waive and release Liquid Amber Tattoo, its staff, and practitioners from all liability for any claims or damages arising from my piercing, including those caused by negligence, to the fullest extent permitted by law

This Document *

I acknowledge that I have been given adequate opportunity to read and understand this document, and I understand that I am signing a legal contract waiving certain rights to recover against the practitioner and Liquid Amber Tattoo

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:

Postcode:

Date of birth:*

If you are under 18 your parent/guardian will be required

Phone #:*

Email:*

Signature:*

Sign above or type signature:

Emergency Contact

If something happens, your emergency contact might need to explain your medical history, allergies, or medications.

Name:

Phone #:

Photo ID*

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