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Thank you for choosing Immaculate Piercing!

 

Please complete this non-piercing service waiver the day before your scheduled appointment and submit no later than midnight. Please do not fill it out too early, the questions below are time sensitive! 

If we do not receive your release form by midnight (EST) the day before your appointment, we may require you to reschedule your appointment and you may forfeit your deposit. Nobody wants that! :) 


If you have booked a same-day appointment, please complete this form immediately so that we can prepare for your visit. 


If you have any questions concerning the release forms, please don't hesitate to reach out to us, we are always happy to help! You can contact us via email at info@immaculatepiercing.com or text our dedicated appointment line: 803-814-3992 (11am-7pm M-F). 


Thank you! 



 

BY SIGNING THIS DOCUMENT, I certify under penalty of perjury that the information below is true and correct. I further understand that if I give false information, or produce false documents stating my name and/or age to be other than correct, then I am liable for prosecution.

Fill out the waiver by scanning Your Driver's License

This scanner is designed as an optional onsite tool to streamline the waiver-signing process. If you are not at the business' location or prefer not to scan your license please skip this option and proceed below to fill out the waiver.

Click the button below to start scanning:

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Please select who will be receiving a piercing...
AdultMinor
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First Client's Name

First Name*

Last Name*

Phone*
First Client's Date of Birth*
First Client's Preferences

Preferred Name

Preferred Pronouns
First Client's Signature*
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 here to join our mailing list!
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*
Choose your service! Remember: No services for mouth piercings at this time!
Which service are you receiving?*

Tell us a little more about your visit! Which piercing needs new jewelry? Which area are we consulting on? Are you picking up a special order? Is there anything else you think we should know? *
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. PLEASE READ THOROUGHLY!!! Both parent and child must provide state-issued photo ID, such as a driver's license, permit, or state-issued ID card. Addresses MUST match, unless there is court documentation proving the custodial relationship. If LAST NAMES are different, please provide a copy of the minor's (full form) birth certificate, marriage license showing name change, or court documented custody.


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*

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Preferences

Preferred Name

Preferred Pronouns
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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