Consent to Pierce and Release Of Claims

Please enable JavaScript in your browser to complete this form.


 

 

 

 

I acknowledge by signing this Release that I have been given the full opportunity to ask any and all questions which I might have about obtaining a piercing from an Ink Villains Tattoo’s Piercer/Employee and all my questions have been answered to my life and total satisfaction. I acknowledge I have been advised of the matters set forth below and I agree as follows.

1). I am not pregnant or nursing. If I have any condition that might affect the healing of a piercing, I will inform my piercer.

2). I do not suffer from medical or skin conditions such as, but not limited to; keloid or hypertroic scarring, psoriasis at the site of the piercing.

3). I am not under the influence of drugs or alcohol. I do not have and physical, mental or medical impairment or disability which might affect my well being a,ra direct or indirect result to my decision to have a piercing done at this time. _

4). I acknowledge that obtaining this piercing is my choice alone and will result to a permanent change to my appearance, and that no representation has been made to me as to the ability to restore the skin involved in this piercing to its pre-piercing condition.

5). I acknowledge infection is always possible as a result of obtaining a piercing. I have received aftercare instructions and I agree to FOLLOW them all while my piercing is healing.

6). I understand that I will be pierced by using appropriate instruments and sterilization.

7). I give all Rights to (Ink Villains Tattoos) take pictures and video for promotional and business related purpose.

Location of Piercing

I understand generally all piercings usually takes 2 – 8 months or longer to heal. I agree to release and forever discharge and hold harmless the piercer and all employees from and claims, damages or legal action arising from or connected in any way with my piercing, or the procedure and conduct used in my piercing.

Name
Address
Click or drag files to this area to upload. You can upload up to 2 files.
Physician Name
Emergency Contact Name
if None type “NONE”
Do you have a history of bleeding disorders:
Have you ever contacted or have now (Hepatitis A,B,C or Syphilis or HIV+)
Are you a Returning Customer?

5 + 6 =

Clear Signature

Verified by MonsterInsights