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Body Piercing
Let us do this part
Today's Date:
Sat Aug 2 2025 11:38
Practitioner:*
Body Piercing Location:*
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The most efficient way to get started is to download the Loylap application on your smartphone.
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Please read and answer
Y
N
Eaten*
Have you eaten in the past 4hrs? It's a good idea to eat something before hand to increase your blood sugar levels.
Y
N
Bloodbourne Pathogens*
Do you have any bloodbourne pathogens, transmittable diseases or recent illnesses? (It' okay if you do, we just want to know for our and other's safety).
Risks*
I confirm that 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 and 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*
TO WAIVE AND RELEASE to the fullest extent permitted by law each of the Artist and the Piercing Studio 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 Artist or the Piercing Studio, or otherwise.
Questions*
I confirm that both the Artist and the Piercing Studio have given me the full opportunity to ask any and all questions about the piercing procedure and the they have been answered to my total satisfaction.
Aftercare*
Aftercare instructions are available on our website, under /aftercare.
An email will also be sent in the provided email address upon completion of the form.
I affirm that I have been given instructions on the care of my piercing while it's healing, I understand them and will follow them. I acknowledge that it is possible that the piercing can become infected, particularly if I do not follow the instructions.
Jewellery Care*
We always check the jewellery upon receiving stock and also twice before fitting. You should also check your piercing jewellery please.
The jewellery is delicate by its very nature and is designed to be removable by the user, so they can come loose whilst handling or cleaning. Our quality control involves checking all the jewellery parts multiple times (3+) before fitting. To the best of our knowledge they are free from defects and are fitted securely.

You must regularly check and tighten the attachments on your jewellery.
Unfortunately, losses are not covered. Your purchased item is your property and is under your care and liability from the time you leave the studio.

I understand that I must regularly check and tighten the attachments on my jewellery. If I loose my jewellery, a replacement must be purchased again.
Duress*
I affirm that I am not under the influence of alcohol or drugs, and I am voluntarily getting a piercing without duress.
Medical Conditions*
I affirm that I do not have diabetes, epilepsy, hemophilia, nor do I have a heart condition or take blood thinning medication. I do not have any other medical or skin condition that may interfere with the procedure or healing of the piercing. I am not the recipient of an organ or bone marrow transplant or, if I am, I have taken the prescribed preventive regimen of anti-biotics that is required by my doctor in advance of any invasive procedure such as piercing. I am not pregnant or nursing.
Permanent change*
I acknowledge that the piercing will result in a permanent change to my appearance and that my skin may not be restored to its pre-piercing condition even after its removal.
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.
Attorney Fees*
I agree to reimburse each of the Artist and the Piercing Studio 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 agree that the courts of Ireland shall have personal jurisdiction and venue over me and shall have exclusive jurisdiction for the purpose of litigating any dispute arising out of or related to this agreement.
Photography*
I release all rights to any photographs taken of me and the piercing and give consent in advance to their reproduction in print or electronic form.
Maternity*
I confirm that I am not pregnant and I am not breastfeeding.
ID Check*
I confirm that I have presented valid government issued photo ID to a member of Piercer Charlie's Creations staff.
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:*


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