←
Change Over
Let us do this part
Today's Date:
Fri Jan 9 2026 09:12
Location:*
Please read and answer
Y
N
Eaten*
Have you eaten in the past 4 hours? It's a good idea to increase your blood sugar levels before your piercing.
Risks*
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, 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.
Release*
I waive and release, to the fullest extent permitted by law, the practitioner and the piercing studio from all liability, and for any and all claims or causes of action that I, my estate, heirs, or executors, may have, for personal injury or otherwise. This includes any direct and/or consequential damages which result or arise, whether caused by the negligence or fault of either the practitioner or the piercing studio, or otherwise.
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.
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:*
Sign up for our newsletter
Social Handle:
If you don't mind us tagging you in photos online
Signature:*