Body Piercing

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Let us do this part

Today's Date:

Fri May 10 2024 04:27

Practitioner:*

Which Body Piercing:*

Service Date:*

Body Piercing Release Form

Photo ID*

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

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.

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 our and other's safety).

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. If you have questions please call the studio.

Release*

TO WAIVE AND RELEASE to the fullest extent permitted by law each of the Artist and Arcane Body Arts 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 Piercing Studio, or otherwise.

Questions*

That both the Artist and Arcane Body Arts have given me the full opportunity to ask any and all questions about the piercing procedure and the they have been answered to my total satisfaction.
If you have questions please call the studio. You may also ask more questions during your appointment.

Aftercare*

*You will be given aftercare instructions after the piercing*

I affirm that the studio will give instructions on the care of my piercing while it's healing, and I will follow them. I affirm that any questions I have regarding the aftercare will be asked. 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.

Medical Conditions*

I affirm that if I have any condition that my piercer needs to be aware of, that I will disclose it prior to receiving my piercing (i.e.epilepsy or hemophilia). I affirm that if I have any of the following conditions, such as but not limited to, diabetes, epilepsy, hemophilia, a heart condition or am taking blood thinning medication that I am aware of additional risks and will discuss with my piercer any questions I may have prior to receiving my piercing. And should I have any other medical or skin condition that may interfere with the procedure or healing of the piercing, I understand there are additional risks. 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.

Pregnancy*

I affirm that I am not pregnant or nursing.

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.

Attorney Fees*

I agree to reimburse each of the Artist and the Piercing Studio for any attorneys. fees and costs incurred in any legal action I bring against either the Artist or Arcane Body Arts and in which either the Artist or Arcane Body Arts the prevailing party. I agree that the courts of British Columbia 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*

If a photo is taken, 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.

*Checking this box does not necessarily mean we will take a photo, we will always ask you first*

Jewellery *

I agree to follow any and all advice regarding the care of my jewellery and also understand that the studio and/or piercer are not responsible for lost jewellery.

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 (lakes, ocean, hot tub, pools), exercise that causes 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.

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.

How did you hear about us?

If you have a preferred name different from your legal name please include it under your full legal name in the designated line on the form below!

If you have a preferred pronoun, please feel free to let us know!

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:

Postcode:

Date of birth:*

If you are under 16 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 #:*