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Waiver for those receiving our piercing services

Rules of our Studio

  1. Absolutely no food or drink outside of the lobby. Please do not ask.
  2. Unless your child has an appointment for an ear piercing, children are not allowed anywhere in the studio.
  3. Do not go into service rooms unless you are invited.
  4. Each customer may have ONE friend joining them in a service area.
  5. A valid government issued I.D. must be presented before all services. No I.D. No service..
  6. We reserve the right to refuse service to anyone.
  7. If you need to smoke please do not smoke outside our doors.
  8. No screaming or yelling.
  9. Please respect the studio and it's staff.
  10. Do not change or remove body jewelry in the studio unless assisted by staff members.

Aftercare purchase is required for service. 

The healing process of your piercing is the most important phase and is the phase in which the most damage can happen. To prevent people from using non recommended products or home remedies, we require everyone who receives a service to purchase our approved aftercare. The aftercare is from NeilMed and is sold for the current MSRP set by the manufacturer. This helps keep the integrity of your piercing after you leave the studio.

Taxes on Services and Surcharges

There is no sales tax in Florida for services. However there is a 7.5% Environmental Health surcharge on all services. 

Waiver and Liability Release

To my knowledge I do not have any mental or medical impairment or disability which might affect my well being as a direct or indirect result of my decision to have any piercing procedure done at this time.

I agree to follow all instructions concerning the care of my piercing while it's healing. I agree that any follow up work due to my negligence will be done at my own expense.

I agree for myself, my heirs, assigns and legal representatives to hold harmless from all damages, actions, causes of action, claim judgements, costs of litigations, attorney's fees and all other costs and expenses which might arise from my decision to have any service performed by East Coast Worldwide Studios Inc.

I agree to pay for any and all damages and injuries to any persons and property belonging to East Coast Worldwide Studios, Inc or any other person whom they may become liable contractually or by operation of law, caused by or resulting from my decision to have any performed work done by East Coast Worldwide Studios Inc.

I hereby grant irrevocable authorization for use of any reproduction by East Coast Worldwide Studios Inc, and and all photographs or videos which are taken of this day of me, negative or positive proof which will be hereby attached for any purposes whatsoever, without further compensation to me. All negatives, together with the prints, video, or live internet stream shall become and remain the property of East Coast Worldwide Studios Inc, soley and completely.

I swear and affirm and agree that the information is true and correct. I have been provided with information describing the piercing procedure to be performed and instructions on aftercare. I have been made aware that if I have any signs or symptons of infections, swelling, pain, redness, warmth, fever, unusual discharge, or odor to contact my physician. I also acknowledge it is also my responsibility to take care of my piercing according to the instructions provided both verbally and in writing.

I understand that if I terminate the service early I will be charged full price for the service, and will not be credited or partially charged. If my body displays any signs or symptons of infections, swelling, pain, redness, warmth, fever, unusual discharge, or odor the session will be ended by the artist as part of his/her professional responsibility. Any subsequent visits to finish the service by the same artist will result in a charge of or studio minimum for the service to cover the costs of setup.

Please remove all sharp objects from your person before laying on our equipment to prevent holes or tears. Holes or tears render the furniture uncleanable and you will be responsible for cost of repair or replacement.

December 21, 2024


Staff Signature

Bradley Byrd
Staff Signature
 December 21, 2024





Who is getting pierced?
AdultMinor
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First Client's Name

First Name*

Middle Name

Last Name*

Phone*
First Client's Date of Birth*
First Client's Dr. Contact Information
Which Doctor would you like us to call in case of emergency? (We will call 911 and give this information to them)*
Ascension St Vincent's Southside - 4201 Belfort Rd, Jacksonville FL 32217 904-296-3700
Other

If Other, What is your doctors name?

Doctor's Address

Doctor's Phone Number
First Client's Signature*
Race (Required by Florida Statute for body piercing.
Which race or ethnicity best describes you*

If other, specify here:
Client's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*
Check to receive information, news, and discounts by e-mail.
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
Parent or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*
Emergency Contact (Required by State)

Emergency Contact First Name *

Emergency Contact Last Name *

Phone Number *

Street Address *

City *

State *
Medical History (selecting yes does not automatically disqualify you)
Are you pregnant?*
No
Yes
Are you under the influence of any substance?*
No
Yes
Do you have a history of bleeding disorders?*
No
Yes

Please list any allergies (if none leave blank)
Description of your piercing.

What kind of piercing(s) are you requesting? *

Location of piercing on your body *

Name of person piercing you today *
How did you hear about us?
How did you hear about us?*

If "other" please tell us how!! If "friend" please tell us who!
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above. A notarized affidavit is required. If your names do not match on your ID's then additional paperwork will be necessary.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Dr. Contact Information
Which Doctor would you like us to call in case of emergency? (We will call 911 and give this information to them)*
Ascension St Vincent's Southside - 4201 Belfort Rd, Jacksonville FL 32217 904-296-3700
Other

If Other, What is your doctors name?

Doctor's Address

Doctor's Phone Number
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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