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Forbidden Anchor Tattoo Consent & Release Form
(Piercing)

I acknowledge by signing this release I have been given the full opportunity to ask any and all questions that I might have about obtaining a piercing from Forbidden Anchor Tattoo, and all my questions have been answered to my full and total satisfaction. 

I Agree

I acknowledge I have been advised of the matters set forth below and agree as follows:

  • Body piercing, a form of body modification, is the practice of puncturing or cutting a part of the human body, creating an opening in which jewelry may be worn. The word piercing can refer to the act or practice of body piercing, or to an opening in the body created by this act or practice.

I Agree

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

I Agree

  • I do not suffer from medical or skin conditions such as, but not limited to: keloid or hypertrophic scarring, psoriasis at the site of the piercing or any open wounds or lesions at the site of the piercing. I do not have any history of herpes at the procedure site. I do not have diabetes, hemophilia, or any other bleeding / blood disorder or cardiac valve disease. Or if I do have any of the above mentioned I am up to date with my current medication and or treatment. I am not currently using medication, including beng prescribed antibiotics prior to dental or surgical procedures. 

I Agree

  • I have advised the piercer of any allergies to metals, latex gloves, soaps and medications. I acknowledge it is not reasonably possible for the piercer to determine whether I might have an allergic reaction to the piercing, or processes involved in the piercing, and further acknowledge that such a reaction is possible.

I Agree

  • I have truthfully represented to the piercer I am over the age of 18 years, or am being accompanied by a parent / guardian with state / government issued ID. I am not under the influence of drugs or alcohol. To my knowledge, I do not have any physical, mental, or medical impairment, or disability, which might affect my well-being as a direct or indirect result of my decision to have a piercing done at this time.

I Agree

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

I Agree

  • I acknowledge infection is always possible as a result of obtaining a piercing, particularly in the event that I do not take proper care of my piercing. I have received aftercare instructions and I agree to follow all of them while my piercing is healing. I agree that any re-piercing needed, due to my own negligence, will be done at my own expense.

I Agree

  • I understand I will be pierced using appropriate instruments and sterilization. I understand that healing time for piercing can vary, but usually takes up to one (1) month or longer to heal.

I Agree

  • I agree for myself, my heirs, assigns and legal representatives, to hold Forbidden Anchor Tattoo 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 tattoo related work done by Forbidden Anchor Tattoo.

I Agree

  • I agree that these waivers also pertain to and are designed to protect any and all establishments where Forbidden Anchor Tattoo conducts business.

I Agree

  • I release all rights to any photographs taken of me and the tattoo and give consent in advance to their reproduction in print or electronic form.

I Agree

I agree to all the aforementioned terms

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Gender / Preferred Gender Pronoun

Gender / PGP
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Gender / Preferred Gender Pronoun

Gender / PGP
Second Participant's Signature*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Gender / Preferred Gender Pronoun

Gender / PGP
Third Participant's Signature*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Gender / Preferred Gender Pronoun

Gender / PGP
Fourth Participant's Signature*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Gender / Preferred Gender Pronoun

Gender / PGP
Fifth Participant's Signature*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Gender / Preferred Gender Pronoun

Gender / PGP
Sixth Participant's Signature*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Gender / Preferred Gender Pronoun

Gender / PGP
Seventh Participant's Signature*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Gender / Preferred Gender Pronoun

Gender / PGP
Eighth Participant's Signature*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Gender / Preferred Gender Pronoun

Gender / PGP
Ninth Participant's Signature*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Gender / Preferred Gender Pronoun

Gender / PGP
Tenth Participant's Signature*
Participant'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*

Confirm Email*
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Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Parent or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*
Piercing Information
Piercer Name*

Piercing Type *

Piercing Location on Body
How did you hear about us?*
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. The same parent or guardian must accompany the minor on the date of the piercing, and present state / government issued ID.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Gender / Preferred Gender Pronoun

Gender / PGP
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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