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Piercing Release Form
Let us do this part
Today's Date:
Wed Oct 7 2026 11:56
Practitioner:*
Piercing Services:*
Jewelry Size/Style:*
This is the Release of All Waivers and Claims and Consent to receive a piercing procedure at Dandyland Tattoo and Body Piercing.

Please read and answer
I acknowledge by signing this release that I have been given the full opportunity to ask any and all questions that I might have about obtaining a piercing from Dandyland, hereafter referred to as the studio.

I acknowledge that all my questions have been answered to my total satisfaction. I specifically acknowledge that I have been advised of the facts and matters set forth below and I agree as follows:
I acknowledge that I have been notified of the possible risks and dangers associated with receiving a body piercing. These risks and dangers include, but are not limited to, the following:

The possibility of discomfort or pain, the possibility of scarring, the possibility of bleeding, the possibility of swelling, the possibility of nerve damage and the risk of infection (particularly in the event that I do not take proper care of my piercing). The increased risk for adolescents during certain stages of development.
I acknowledge that I have truthfully represented to the associated agents and representatives of this studio that I am 18 years of age or older or that I am a minor accompanied by a parent or legal guardian and have provided the documentation required by the Texas Department of Health laws and guidelines to receive a piercing.
I acknowledge that I am not pregnant.
I acknowledge the receipt of written, digital or internet link to instructions advising me of proper care of my piercing and recognize the absolute necessity of following the written instructions.
I acknowledge that the obtaining of the piercing is my choice alone and I consent to the piercing procedure and to any actions or conduct of the associates, agents, or representatives of the studio reasonably necessary to perform this procedure.
I agree to release and forever discharge and forever hold harmless DANDYLAND, its associates, agents, officers and shareholders from any and all claims, damages, or legal actions arising from or connected in any way with my piercing or the procedures and conduct necessary to complete this procedure.
I acknowledge and understand that jewelry is non-refundable and can not be returned.
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:*
Pronouns:
Chosen name:
Address:
Postcode:
Date of birth:*
 
If you are under 18 your parent/guardian will be required
Age: 
Phone #:*
Email:
Signature:*

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