Skye Earlobe Piercing Minors 5yo - 11yo

Let us do this part

Today's Date:

Fri May 9 2025 07:24

Practitioner:*

First time ear piercing?:*

Special Circumstances, Considerations; previous scarring, medical procedures in or around the area, etc:

Earlobe piercing release form for children 5yo - 11yo
THE ONLY ADULTS WHO CAN SIGN FOR MINORS ARE PARENTS, STEP PARENTS, AND COURT ISSUED LEGAL GUARDIANS WITH PAPERWORK.
Please answer the below questions for the minor receiving the service.

Please read and answer

Piercer's Decision*

I acknowledge that my piercer has the right to stop our appointment at any time if they do not think that the child can sit through it safely. Client and piercer safety is the priority at all times.

The piercer will give them every opportunity to have a successful piercing attempt, that is why the appointment is booked for an hour.

Held Jewelry*

In the case of an unsuccessful piercing attempt, the jewelry will be held for 1 year from date of 1st appointment.
After 1 year, unless previously discussed, the jewelry will be tossed.
The piercer will reach out every 3-4 months to be in contact to check in and see if the jewelry is still wanted.

Cost 1st Attempt*

In the case of a FIRST unsuccessful piercing, there will be a $50 fee. That fee covers the cost of setup, autoclaving, and the time of the appointment.
That $50 fee will come off of the $75 ear piercing fee at the date of the successful ear piercing, bringing the new cost to $25 + cost of jewelry

Cost 2nd Attempt

In the case of a SECOND unsuccessful piercing, there will be a $25 fee. That is to cover setup, supplies, and the time of the appointment.
This fee will NOT be applied to the final total for the ear piercing.

Consent*

As the parent, step parent, grandparent, or legal guardian of this child, I consent for the piercing

Eaten*

I have made sure that my child has eaten sufficiently in the last 4 hours.
It is important to be nourished before putting the body through stress to prevent passing out and encourage an optimal healing response.

Risks*

I agree that there is a risk involved with any and all piercings.
These can include but not limited to:
infection, scarring, keloids, migration of the piercing, and rejection of the piercing.

The piercer will be going over information with you before/during/after the piercing.

Questions*

By checking this box, I agree to ask any questions that come up about my piercing/piercing experience, and I know that I have the option to reach out to the artist as well if any future questions come up

Aftercare*

I acknowledge that I will be going over aftercare instructions with my piercer once the piercing is completed. I acknowledge that I will be going home with a written copy of care instruction for my reference at home in case I forget anything.

I agree to follow them to the best of my ability.
I acknowledge that it is possible that the piercing can become infected, particularly if I do not follow the instructions. I understand the Piercer's suggestions are not to be confused with medical advice.

Permanent change*

I acknowledge that the piercing will result in a permanent change to my appearance. My skin may not be restored to its pre-piercing condition even after its removal.

Jewelry and Procedure*

I understand that the piercer or ISTARI LLC DBA SKYE TATTOO cannot be held responsible if my body reacts negatively to the metal of the jewelry.

We only pierce with Implant Certified Titanium (ASTM F-136) milled on CNC (Computer Numerical Control) machines out of solid implant-grade titanium (ASTM F136 6AI-4V ELI) that is sourced in the United States. There are options for 14k + 18k gold as well.

Only approximately 0.6% of the population is allergic to titanium. If you are or suspect you are, please advise your artist immediately and seek testing from you primary care provider.

I also understand that sterilized jewelry and equipment and/or single use disposables will be used for my piercing.

Symptomatic Allergies/Signs of Sickness*

Do you agree that symptoms of illness or severe allergies will require rescheduling of your appointment? Due to health concerns, concerns for our clients, the shop environment and artists, all allergy symptoms or symptoms of being sick ie: coughing, sneezing, runny nose, sore throat etc will require the appointment to be rescheduled or stopped. Even with just having allergy symptoms this still applies because coughing and sneezing can still transmit an asymptomatic Covid-19 infection. This applies for the artist as well and may require your artists to reschedule.

Jewelry Switch-outs *

I understand that I may need longer or larger jewelry inserted initially to account for swelling. I may need a smaller size or a piece of jewelry with a shorter post inserted after my piercing has healed for a healthier and more comfortable fit. This piece of jewelry will still be charged for as well as an insertion fee.

Photography*

I acknowledge that there is the chance of having a picture taken with my consent ONLY.

I release all rights for any photographs or videos taken of me and the piercing. I give consent in advance to their reproduction in print or electronic form. This does NOT mean that every encounter will be filmed or photographed, your artist will ask for verbal consent during the time of the appointment.

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.

Medical Conditions*

I agree to let my artist know that if I have diabetes, epilepsy, hemophilia, heart condition, take blood thinning medications or have any ailments that could effect this procedure or healing.
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.

Details:

Bloodbourne Pathogens*

Do you have any blood borne pathogens, transmittable diseases or recent illnesses? This does not stop the service, it is just to inform your artist.

Details:

Medication*

Are you taking any medications that can thin the blood? If yes, it does not stop the piercing process. It just informs the piercer so they can set up to accommodate your needs as best as possible

Skin Conditions*

I agree to let my artist know if I have any skin conditions, including but not limited to: psoriasis, eczema, rosacea, acne, or any other skin condition that could impact placement and healing of piercings.

Details:

Recent Symptoms of Illness*

Have you or any member of your household experienced symptoms of a viral infection? Any of the following: Fever, loss of taste or smell, dry cough, running nose, sore throat, or shortness of breath in the past 14 days?

Recent Exposure of Covid-19*

Have you or any family member of your household tested positive, or been exposed to someone who has tested positive, for a viral infection ie: Covid-19 in the last 14 days?

Release*

TO WAIVE AND RELEASE to the fullest extent permitted by law each of the Piercer and ISTARI LLC DBA SKYE TATTOO 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 Piercer or ISTARI LLC DBA SKYE TATTOO, or otherwise.

Global Pandemic*

I agree that there is a current Global Pandemic; Covid-19, AKA 2019 novel coronavirus, 2019-nCoV, SARS-CoV-2 declared by World Health Organization. Covid-19 is extremely contagious. The virus that causes COVID-19 is believed to spread via droplets via respiratory, Aerosolized transmission via living in the air up to 3 hours, Surface transmission via several days. Spread is more likely to occur during close contact with an infected person symptomatic or asymptomatic.

Attorney Fees*

I agree to reimburse each of the Piercer and ISTARI LLC DBA SKYE TATTOO for any attorneys. fees and costs incurred in any legal action I bring against either the Artist or the Piercing Studio and in which either the Artist or the Piercing Studio is the prevailing party. I release Skye Tattoo and it’s agents from liability with regards to any circumstances beyond their control.

Full and Voluntary Assumption of Risk*

ISTARI LLC DBA SKYE TATTOO has engaged and is enforcing preventive measures that follow the CDC and States guidelines to reduce the spread of Covid-19. These preventive measures however are not guaranteed as Covid-19 infection can happen to anyone anywhere. Being inside any business and partaking in services could increase your risk of infection.

I am voluntarily making assumption of risk and that I may be exposed to or infected by entering ISTARI LLC DBA SKYE TATTOO. That may result in personal injury, illness, permanent disability and death. I understand that the risk of becoming exposed to or infected by Covid-19 at ISTARI LLC DBA SKYE TATTOO may result from these actions, omissions, or negligence of myself and others including but not limited to ISTARI LLC DBA SKYE TATTOO's employees, contractors and / or representatives.

How to fill out the next section*

For the below section, legal name, address, phone number, date of birth, and email MUST BE THE CONSENTING ADULT.

Please put your minor's name in the 'chosen name' section as well as what pronouns they use.

Please take a picture of your ID as well as the minor's ID, two photos is fine if need be.

PLEASE MAKE SURE YOU HAVE ANSWERED THE ABOVE QUESTIONS FOR THE MINOR GETTING THE SERVICE.

For the below section, legal name, address, phone number, date of birth, and email MUST BE THE CONSENTING ADULT.

Please put your minor's name in the 'chosen name' section as well as what pronouns they use.

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 18 your parent/guardian will be required

Phone #:*

Email:*

Signature:*

Sign above or type signature:

Parent/Legal Guardian

I, as custodial parent or legal guardian of the above minor under 18 years of age, hereby consent to the terms and conditions set forth in this release form and I attest that all documentation I have provided is true and accurate.

For Parent or Legal Guardian of a Minor: *ALL MINORS ARE REQUIRED TO PROVIDE ID. ID OPTIONS THAT ARE ACCEPTABLE ARE: PASSPORT, PERMIT W/PHOTO, STATE IDENTIFICATION CARD, TRIBAL IDENTIFICATION CARD, BIRTH CERTIFICATE/COPY OF A BIRTH CERTIFICATE, MILITARY ID. THE PRESENT PARENT'S ID MUST HAVE MATCHING LAST NAME OR PROOF OF NAME CHANGE.

Guardian's Legal Name:*

Relationship:*

Signature:*

Photo ID*

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

Take a picture of both parent/legal guardian's identification as well as the minor receiving the piercing. One photo or two separate photos are acceptable. In the case of a legal guardian, we need ID, a photo of the court issued paperwork, and the minor's ID as well.