Body Piercing Waiver & Liability Release

In consideration of receiving a body piercing from "She Pierced It" including its artists, associates, apprentices, agents, or any employees (hereinafter referred to as the “She Pierced It” I agree to the following:

______ - I, __________________, (Print Name) have been fully informed of the inherent risks associated with getting any body piercing/ modification . Therefore, I fully understand that these risks, known and unknown, can lead to injury including but not limited to: infection, scarring, and other difficulties. Having been informed of the potential risks associated with getting a body piercing, I wish to proceed with the piercing procedures and jewelry installation and freely accept and expressly assume any and all risks that may arise from my body piercing.

______ - I WAIVE AND RELEASE to the fullest extent permitted by law any person of "She Pierced It" from all liability whatsoever, including but not limited to, any and all claims or causes of action that I, my estate, heirs, executors or assigns may have for personal injury or otherwise, including any direct and/or consequential damages, which result or arise from the procedure of my body piercing, whether caused by the negligence or fault of either "She Pierced It", or otherwise.

______ - "She Pierced It" has given me the full opportunity to ask any question about the procedure and application of my body piercing and all of my questions, if any, have been answered to my total satisfaction.

______ - "She Pierced It" has given me instructions on the care of my piercing while it's healing. I understand and will follow them. I acknowledge that it is possible for my piercing to become infected, particularly if I do not follow the instructions given to me. I affirm I was told where to purchase aftercare as well as offered to purchase some in shop. If any work to the piercing is needed due to my own negligence, I agree that the work will be done at my own expense.

______ - I am not under the influence of alcohol or drugs, and I am voluntarily submitting to be pierced by "She Pierced It" without duress or coercion.

______ - I do not suffer from diabetes, epilepsy, hemophilia, heart condition(s), nor do I take blood thinning medication. I do not have any other medical or skin condition that may interfere with the procedure of my piercing. I am not the recipient of an organ or bone marrow transplant or, if I am, I have taken the prescribed preventative regimen of antibiotics that is required by my doctor in advance of any invasive procedure such as a piercing. I am not pregnant or nursing. I do not have a mental impairment that may affect my judgement in getting a body piercing .

______ - I release the right to any photographs taken of me and the piercing and give consent in advance to their reproduction in print or electronic form. (For assurance, if you do not initial this provision, please inform "She Pierced It" NOT to take any pictures of you and your completed piercing ).

______ - I agree that "She Pierced It" has a NO REFUND policy on, piercing and/or retail sales and I will not ask for a refund for any reason whatsoever.

______ - I acknowledge that I have been given adequate opportunity to read and understand this document that it was not presented to me at the last minute and grasp that I am signing a legal contract waiving certain rights to recover damages against "She Pierced It".

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.

I hereby declare that I am of legal age (and have provided valid proof of age and identification) and am competent to sign this Agreement.

I HAVE READ THE AGREEMENT, I UNDERSTAND IT, AND I AGREE TO BE BOUND BY IT.

Signature __________________________
Print: ______________________ Address: ___________________________________ Date of Birth: ___/___/___ City: ___________________ State: ______________ Form of Identification: __________________________

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______ - I WAIVE AND RELEASE to the fullest extent permitted by law any person of "She Pierced It" from all liability whatsoever, including but not limited to, any and all claims or causes of action that I, my estate, heirs, executors or assigns may have for personal injury or otherwise, including any direct and/or consequential damages, which result or arise from the procedure of my body piercing, whether caused by the negligence or fault of either "She Pierced It", or otherwise.

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______ - I am not under the influence of alcohol or drugs, and I am voluntarily submitting to be pierced by "She Pierced It" without duress or coercion.

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______ - I agree that "She Pierced It" has a NO REFUND policy on, piercing and/or retail sales and I will not ask for a refund for any reason whatsoever. [initila]

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I hereby declare that I am of legal age (and have provided valid proof of age and identification) and am competent to sign this Agreement.

I HAVE READ THE AGREEMENT, I UNDERSTAND IT, AND I AGREE TO BE BOUND BY IT.

Signature __________________________
Print: ______________________ Address: ___________________________________ Date of Birth: ___/___/___ City: ___________________ State: ______________ Form of Identification: __________________________

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First Clients Name

First Name*

Last Name*

Phone*

First Clients Date of Birth*

First Clients Signature*

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Parent or Guardian's Email Address

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Parent or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*

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.

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*

Address Line 1:*

Street address, P.O. box, company name, c/o

Address Line 2:

Apartment, suite, unit, building, floor, etc.

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Parent or Guardian's Date of Birth*

Parent or Guardian's Signature*

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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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