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Jewelry Change Out
Let us do this part
Today's Date:
Sun May 5 2024 01:39
Please read and answer
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N
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I hereby give consent to Zen Ink, LLC to remove my body piercing or change my jewelry, and in consideration of doing so, I hereby release and forever discharge and hold harmless Zen Ink, LLC, the Piercer and all affiliates, Owners, Managers and Independent Contractors from any and all claims, damages or legal actions arising from or connected in any way with my procedure and conduct used in my performing my procedure, to the fullest extent allowed by the law.
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I agree to speak softly and silence my cell phone in order to help keep a calm, spa like environment.
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I am at least 18 years old.
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N
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Are you pregnant/breastfeeding?
Details:
 
Y
N
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Have you eaten in the last 5 hours?
Y
N
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Are you prone to fainting?
Y
N
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Are you allergic to? Lavender, Tea tree, Witch Hazel
Details:
 
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N
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Can we post a photo of your piercing on social media?
I have read this release form and confirm that all the information I have given is correct. I understand that this is a release form and I agree to be legally bound by it.
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.
Legal Name:*
Pronoun:
Chosen name:
Address:
Postcode:
Date of birth:*
Phone #:*
Email:*
Signature:*