PIERCING CONSENT FORM

Please fill out every section and carefully read through the declaration at the bottom. No piercing will commence until we receive confirmation that the form has been filled out. If you look under 25 years old, we will require to see government approved photo ID which we will scan in and keep on record. If you are under 16 years old, we will need to scan your parent/guardian’s ID.

Contact Us

Client Name

Parent/guardian's name

If the client is under the age of 16 years old, this must be filled out. 

Client's Date of Birth

Please note, if you look under 25 years old, you will be asked for ID

Address

Medical Information

Please let us know if any of the following applies to you.

Emergency contact


Please read carefully


I declare that the above information is true and correct to the best of my knowledge. I am of the required age and able to give full consent for the procedure detailed above. I am not under the influence of drugs or alcohol.


I hereby give consent for the piercer named above to carry out the procedure. I understand the potential risks and complications that are associated with the procedure and confirm that I have been given access to the appropriate aftercare advice. I understand that it is my responsibility to carry out the instructions as suggested by the operator to assist the best possible healing conditions for my piercing.


I consent to photographic images to be taken of my piercing and used for advertising or portfolio purposes on social media/print media by both the studio and the piercer. This may extend to third parties given approval by the studio or the piercer


I understand that the studio has CCTV used solely for the protection of the staff, and clients. Footage will be stored on a secure server for a period of 30 days and will be provided to the police if an incident occurs. 


I give consent for the information on this form to be held by the operator and studio for a minimum of two years from the date of the procedure.


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.


Occasionally we would like to send out emails to notify people about promotions, guest artists and cancellations. If you want in, let us know.