Body Piercing Release Form
Let us do this part
Today's Date:
Sun Nov 29 2020 10:10
Practioner:*
What piercing are we doing today?:*
Please read and answer
Age*
I am at least 16 years old. (A PARENTAL RELEASE FORM MUST ALSO BE COMPLETED IF YOU ARE NOT LEGAL AGE.)
COVID-19 Precautions *
I understand that if I am sick, have a fever or cough, have traveled out of province I will notify staff at ON2U. Appointments will have to be rescheduled.
Appointment Requirements*
I understand I must be wearing socks or bring socks to my appointment, I must be on time for my appointment, I am required to wear a mask for the entire visit, I am not allowed extra people in the studio at this time unless you are a parent accompanying a minor, I understand if I do not follow these requirements the staff at ON2U has the right to cancel or reschedule my appointment.
Y
N
Eaten*
Have you eaten in the past 4hrs? It's a good idea to 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).
Details:
 

Risks*
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. I agree not to sue ON2U or its staff, past, or present, for any damages, claims, demands, rights and causes of action of nature whatsoever for any injuries or property damages of myself or to any other persons arising from my decision to have any body-modification work done at ON2U by any person who so ever.
Questions*
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*
I affirm that I will follow all aftercare given to me to care of my piercing while it's healing, and 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.
Duress*
I affirm that I am not under the influence of alcohol or drugs, and I am voluntarily getting a piercing without duress.
Y
N
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.

*If you suffer from any of these conditions please call us at 306-343-7653
Details:
 

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.
Y
N
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.
Details:
 

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.
Personal Info
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:
Prefered name:
Address:
Date of birth:*
If you are under 16 your parent/guardian will be required
Phone #:*
Email:*
Signature:*


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