Piercing Service Consent & Liability Waiver

Please review and complete this piercing waiver.

Provide your details, initial each acknowledgement, and sign before your appointment.

Age Verification

Is the person receiving the piercing 18 years of age or older?

Piercer

Piercer Used

Client Information

First Name

Last Name

Date of Birth

Age

Address

City

State

ZIP

Phone

Photo of Driver's License / ID (required)

Take Photo

Take a clear photo of your government-issued photo ID.

Piercing Details

Body Location to be Pierced

Type of Jewelry

Date of Procedure

Health Information / Declarations

I affirm that I am in good physical and mental health to receive this piercing and have revealed any known conditions that may affect healing (e.g., diabetes, blood disorders, immunosuppression, allergies).

List any known conditions

Risks & Aftercare Acknowledgement

I understand that body piercing involves permanent penetration of the skin, and complications can include (but are not limited to): bleeding, infection, scarring, allergic reactions, nerve damage, embedding of jewelry, and prolonged healing. I agree to follow all aftercare instructions provided by the piercer.

Consent & Release of Liability

By signing this document, I agree:

I willingly and voluntarily consent to the piercing procedure listed above.

I release the shop, the piercer, and all personnel from liability for any adverse outcomes, injuries, infections, or complications resulting from the piercing or aftercare.

I understand that results cannot be guaranteed.

Client Signature

Draw your signature above

Date

Minor Piercees (Under 18)

Because the client is under 18 years of age, this section MUST be completed by a parent or legal guardian.

I, the undersigned parent / legal guardian, give my permission for my minor child listed above to receive the specified piercing at this shop. I also attest that I have provided accurate identification and legal authority to sign this consent.

Minor's Parent/Guardian Name

Relationship to Minor

Parent/Guardian Phone

Parent/Guardian Email

Parent/Guardian Street Address (if different)

City

State

ZIP

I understand the risks associated with body piercing, and I consent to the procedure being performed on my minor child. I agree to the aftercare instructions and will supervise the minor's healing process.

Parent/Guardian Signature

Draw signature above

Date

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