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Piercing Liability
Let us do this part
Today's Date:
Fri Aug 14 2026 07:38
Photo Identification *
Please take photo(s) of your government issued photo IDs and related paperwork
One piece of government issued Photo ID, clearly showing photo, name, and date of birth.
Please read and answer

If you are getting more than one service, please enter your other piercing here.
 
We recommend that you not go swimming or submerging new piercings in standing water for at least 6-8 weeks (or longer if there is irritation). This includes, but is not limited to, oceans, lakes, pools, hot tubs and sit down baths.
Y
N
Have you eaten in the past 4 hours? (It's a good idea to eat beforehand to increase your blood sugar levels!)
Y
N
Do you have any bloodborne pathogens, immune compromising conditions or transmittable diseases? (It's okay if you do, we don't need details, we just want to know for our and other's safety if yes please inform a staff member).
Y
N
Do you have allergic responses to adhesives, creams, metals, iodine, seafood, latex, or wheatgerm?

If so, please make us aware by checking yes and informing a staff member.

Details: 
Y
N
SHOULD a photo be taken of me, I consent in advance to its use or reproduction for broad purposes in any manner without any further consideration or permission.

I understand that if I have the right to refuse photography, and I will make my piercer aware should I not wish to be photographed.
Y
N
Are you pregnant and/or nursing? If YES please inform a staff member. Infections are not common but can occur and can unfortunately travel through the blood stream and put your child at risk.
I understand that there are risks associated with getting a piercing. These risks, which include both known and unknown risk including, but not limited to injury, infection, scarring, allergic reactions and localized swelling, or rejection.

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.
I acknowledge that I will be given instructions on the care of my piercing while it's healing, and I will follow them.

I acknowledge that it is possible that the piercing can become infected, particularly if I do not follow the instructions and aftercare is my responsibility after I leave the studio.
I understand there may be additional costs associated with getting a piercing. Additional aftercare or new jewelry is not free - including downsizing. There is a cost for all replacement jewelry.
I am not under the influence of alcohol, drugs, blood thinners or any other substance which could affect the piercing process, and I am voluntarily submitting to be pierced without duress or coercion.
I affirm that I do not have untreated diabetes, epilepsy, hemophilia, high blood pressure, 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 react adversely to the healing of the piercing. 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.
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.
I HEREBY FOREVER WAIVE, RELEASE and INDEMNIFY to the fullest extent permitted by law each of the Artist and the Tattoo Studio from all liability whatsoever, for any and all claims, cause(s) of action or damages of any kind that I, my estate, heirs, executors or assigns may have, will have or could assert at any time in future for personal injury or any other cause or reason whatsoever, including any direct and/or consequential damages, which result, arise from or in any way be related to the application of my tattoo, whether caused by the negligence or fault of either the Artist or the Tattoo Studio, or otherwise.
In giving consent I release this piercer/artist, establishment and it's employees from all liabilities, actions and demands which I may have now or in the future for any loss or damage suffered; including any direct and/or consequential damages, which result or arise cause as a result of my piercing, caused by myself and/or any negligence or failure on my part.
 
We strive to make your experience with us comfortable and safe! If you have a preferred pronoun, please let us know. If your name is different than your legal name/ID, please utilize the Preferred Name section.

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.
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:
Date of birth:*
 
If you are under 16 your parent/guardian will be required
Age: 
Phone #:*
Email:*
Signature:*