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CONSENT TO PIERCING (MINORS)
Let us do this part
Today's Date:
Tue Apr 23 2024 06:23
Please read and answer
What piercing did you come in for today?
*
-- Select --
Check Up
Daith (Age 15 and up)
Eyebrow (Age 15 and up)
Helix (Cartilage) (Age 13 and up)
Industrial (Age 15 and up)
Labret (Age 15 and up)
Lobe (Pair) (Age 8 and up)
Lobe (Single) (Age 8 and up)
Navel (Age 15 and up)
Nostril (Age 15 and up)
Other
Outer Conch (Age 15 and up)
Philtrum (Medusa) (Age 15 and up)
Rook (Age 15 and up)
Septum (Age 15 and up)
Smiley (Age 15 and up)
Snug (Age 15 and up)
Tongue (Age 17 and up)
Tongue Web (Age 17 and up)
Tragus (Age 15 and up)
Check after reading all conditions
*
I am not sick. If I have any conditions that might affect the healing of this piercing or my health, I will inform my piercer.
I have advised the piercer of any allergies to metals, latex gloves, soaps and medications. I acknowledge it is not reasonably possible for the piercer to determine whether I might have an allergic reaction to the piercing or processes involved in the piercing and further acknowledge that such a reaction is possible.
(Parent)
I have trustfully represented to the piercer and staff that I am over the age of 18 years. I am not under the influence of drugs or alcohol. To my knowledge, I do not have any physical, mental or medical impairment or disability which might affect my well-being as a direct or indirect result of my decision to have a piercing done at this time.
I acknowledge that obtaining this piercing is my choice alone and will result in a permanent change to my appearance, and that non representation has been made to me as to the ability to later restore the skin involved in this piercing to it's pre-pierced condition.
I acknowledge infection is always possible as a result of obtaining a piercing. I have received aftercare instructions and I agree to follow all of them while my piercing is healing. I understand I will be pierced using appropriately sterilized jewelry and instruments.
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.
Name:
*
Address:
*
Postcode:
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Date of birth:
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If you are under
18
your parent/guardian will be required
Phone #:
*
Email:
*
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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.
Anyone being pierced must consent to piercing verbally. They must be at least 8 years of age, unless given the okay by Eric. An additional fee of $60 after the initial 15 minutes spent with your child will be applied (a set of lobes typically only takes 4 minutes to pierce to completion with a cooperative client). If at any time the client (your child) states they do not wish to have their ears pierced, I will not pierce their ears. It can't be forced upon them, and I can't pierce an uncomfortable client. If a child cries, you will be asked to leave the shop to console your child to maintain a comfortable environment for other clients and myself. A child who is moving/flinching puts both myself and them in a dangerous situation. We have sent clients away with a single lobe piercing, or no lobe piercings, and will not work with a child who isn't prepared. BE SURE ABOUT THIS. There is a $20 charge for wasted supplies, even if your child gets no piercings.
Guardian's Legal Name:
*
Relationship:
*
-select-
Natural guardian (birth parent)
Legal parent via marriage
Legal guardian via adoption
Other (provide proof)
Signature:
*
Photo ID
*
Please take photo(s) of your government issued photo IDs and related paperwork.
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