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PIERCING CONSENT FORM

Let us do this part
Today's Date:
Sat Aug 2 2025 10:58
WAIVER, RELEASE AND CONSENT FOR PIERCING

Please read and be certain you understand the implications of signing


In consideration of receiving a Piercing from (PLUG TATTOO) and (it’s employees, apprentice and agents, here and after collectively referred to as ‘’Plug Tattoo’’), I agree to the following
Please read and answer
Piercing Waiver and Consent Form*
Waiver of Liability
I hereby WAIVE AND RELEASE, to the fullest extent permitted by law, each of the Piercer and the Tattoo 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 from the application of my piercing, whether caused by the negligence or fault of either the Piercer or the Tattoo Studio, or otherwise.
Acknowledgment of Information and Aftercare*
I acknowledge that both the Piercer and the Tattoo Studio have given me the full opportunity to ask any and all questions about the application of my tattoo or piercing, and all of my questions have been answered to my total satisfaction. I will receive and understand the instructions on the care of my Piercing while it is healing and agree to follow them. I understand that improper care may lead to complications such as infection, and I acknowledge that any touch-up work required due to my negligence will be at my own expense.
Health Assurance*
I assure that I am not under the influence of alcohol or drugs and am voluntarily submitting to be tattooed or pierced by the Artist without duress or coercion. I also assure that I DO NOT HAVE any medical conditions that may interfere with the application or healing of the tattoo or piercing, including but not limited to diabetes, epilepsy, hemophilia, heart conditions, nickel allergies, or the use of blood-thinning medications. I am not pregnant or nursing, and I do not have any mental impairment that may affect my judgment in getting the tattoo or piercing. If I suffer from Hepatitis or any other communicable diseases, I have informed the Piercer and have been advised of the necessary precautions.
Allergy and Reaction Acknowledgment*
I have advised the Piercer of any allergies to metals, latex, soaps, and medications. I acknowledge that it is not possible for the Artist to determine whether I might have an allergic reaction to the tattoo, piercing, or process involved, and further acknowledge that such a reaction is possible.
Y
N
Jewelry Acknowledgment*
I brought my own jewelry. By checking this box, I acknowledge that it is fully my decision to consent to Plug Tattoo using/installing my jewelry purchased elsewhere. I release Plug Tattoo and all of its employees, managers, owners, piercing and from all manner of liabilities, claims, potential jewelry/skin damage, actions, and demands, which I or my heirs may have now or hereafter by reason of giving consent for Plug Tattoo to pierce/install jewelry upon myself and/or my child/dependent.
Y
N
Photography Consent*
I release all rights to any photographs taken of me and the tattoo or piercing, and give consent to their reproduction in print or electronic form. (If you do not initial this provision, please advise and remind your Artist and the Tattoo Studio that there are to be NO pictures taken of you or your completed piercing.)

if answered ( NO ) please advise your Piercer.
Consent Acknowledgment*
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 that I understand I am signing a legal contract waiving certain rights to recover against the Piercer and the Tattoo Studio. By check boxing this box, I acknowledge that this waiver covers any tattoo or piercing work done today.

By signing below, I affirm that I have read and fully understand the above information and that I agree to be legally bound by this consent form
Thank you for submitting your waiver please let the receptionist know you are done!
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:*
Date of birth:*
If you are under 18 your parent/guardian will be required
Phone #:*
Email:
Signature:*


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