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Piercing Release English Release Form

Let us do this part
Today's Date:
Thu Mar 23 2023 11:24
Practitioner:*
Piercing Service Consent and Release Form

Please read and answer
 
Chosen Name if Different from Legal Name
 
APPOINTMENT AGREEMENT*
By checking this box I confirm that I understand that I have scheduled an appointment for this service and that I will call to cancel or reschedule if I am unable to make my appointment time. I agree to show up on time for my appointment, and understand that if I am late the service may not be able to be performed.

I agree that if I fail to show up for my appointment and fail to get in touch to cancel or reschedule the appointment an appropriate amount of time prior to the appointment, or am late to the appointment, I may be required to pay a deposit for half the service price to schedule any future appointments.

I understand that this deposit will come off the total of my service at checkout at my appointment.

I understand that if I paid a deposit to schedule an appointment, and I fail to show up for my appointment and fail to call to cancel or reschedule my appointment prior to my appointment time, or am late to my appointment, I forfeit the deposit I paid to schedule the appointment.
 
Minor Piercing Agreement
If this piercing is for a minor, you need to submit GOVERNMENT ISSUED ID for both PARENT/GUARDIAN and MINOR. For the minor, birth certificates, state IDs, passports, tribal, or military IDs will suffice. If using a birth certificate as identification for the minor, please also provide photo ID. If using a birth certificate, a school ID will suffice as photo ID.

If you do not submit proper identification we may have to reschedule your appointment.

If this piercing is for a minor, please complete the form with the MINOR's information, NOT PARENT/GUARDIANS. Once you have completed the form and entered the minor's birthdate, a parental consent section with pop up for the parent to fill out and sign.


Please list the IDs you will be providing for the minor in the space below.

THEN submit pictures of them at the bottom of the form.
 
 
Student?- OPTIONAL
 
 
How did you hear about us? -OPTIONAL
 
 
Piercing Name/Placement on Body -REQUIRED*
 
 
Allergies -OPTIONAL
 
 
Medications -OPTIONAL
 
 
Medical Conditions -OPTIONAL
 
Diabetes
Epilepsy
Asthma
Infections
Hemophilia
Blood Thinners
Heart Condiiton
Faint or Dizzy
Immune Condition
Steroid Medication
Psoriasis/Eczema
TB
Scarring/Keloids
Herpes
Hepatitis
HIV/AIDS
Pregnant
Nursing
Positive responses to any of these questions will likely indicate a deeper discussion with your artist before proceeding with your body modification
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.
Personal Info
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.
Name:*
Pronoun:
Address:*
Postcode:
Date of birth:*
If you are under 18 your parent/guardian will be required
Phone #:*
Email:*
Signature:*


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