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True Expression

91-22 59th Ave.

Elmhurst, NY 11373

I, at this moment, induce the staff of True Expression Piercing Studio to perform a body piercing (and service). In consideration of doing so, I now release the body piercer, True Expression Piercing Studio, and their staff, from all manner of liabilities, claims, actions, and demands in law, or in equity, which I or my heirs might now or hereafter by reason of complying with my request to receive body piercing(s). I fully understand that the body piercer, in performing a body piercing, does not act in the capacity of a medical professional. The suggestions made by the body piercer are just suggestions. They are not to be construed as, or substituted for, advice from a medical professional. I understand that I will be pierced (or any installation of jewelry), using appropriate aseptic techniques, sterilized equipment, and jewelry. I also understand that infections/irritations can occur due to a lack of proper hygiene and/or mental sensitivities. I understand that this piercing and/or jewelry installation service may leave noticeable, permanent scarring. To ensure proper healing of my piercing, I agree to follow the aftercare procedures suggested in the verbal/written aftercare sheet provided.


I am aware of the risks associated with getting a piercing. I understand that these risks, known and unknown, can lead to injury, including but not limited to infection, scarring, keloids, and allergic reactions. Having been informed of the potential risks associated with getting a piercing, I still wish to proceed with the piercing and I freely accept all risks that may arise from piercing. 


 

I acknowledge that the piercing will result in a permanent change to my appearance and that my skin may not be restored to its pre-piercing condition even after its removal. 


 

I affirm that I have received clearance from my doctor to proceed with this piercing having a medical condition. Any of the following conditions stated may interfere with the procedure or healing of the piercing and should be discussed with your doctor; medical conditions: diabetes, epilepsy, hemophilia, heart condition, taking blood thinning medication, skin condition, recipient of an organ or bone marrow transplant)


 

I affirm that I am not under the influence of alcohol or drugs, and I am voluntarily getting a piercing without duress. 


 

I am not pregnant or nursing. (It is advisable to refrain from undergoing any body art procedures during a pregnancy, even just an ear lobe stretch. It is best to let your body focus on the important, complex, and demanding task presently at hand)


 

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 I understand that I am signing a legal contract. 


 

I understand that the artist will take pictures of my piercing, which will be sent to me via email, to monitor the healing of my piercing. 


 


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First Client's Name
First Name*
Last Name*
Phone*
First Client's Date of Birth*
Date of Birth
Additional Info (optional)
Preferred Name
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.
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City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address
Email*
Confirm Email*
Check to receive information, news, and discounts by e-mail.
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*
Parent or Guardian's Date of Birth*
Date of Birth
Additional Info (optional)
Preferred Name
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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