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WGTATTOOS , 171 ROMAN BANK, SKEGNESS, PE251RY

PIERCING WAIVER.

Pease read the following thoroughly. After completing the waiver, You will be required to provide any forms of valid id to wgtattoos counter staff.

First Clients Name

First Name*

Middle Name

Last Name*

Phone*
First Clients Date of Birth*
First Clients Signature*
Second Clients Name

First Name*

Middle Name

Last Name*

Phone*
Second Clients Date of Birth*
Third Clients Name

First Name*

Middle Name

Last Name*

Phone*
Third Clients Date of Birth*
Fourth Clients Name

First Name*

Middle Name

Last Name*

Phone*
Fourth Clients Date of Birth*
Fifth Clients Name

First Name*

Middle Name

Last Name*

Phone*
Fifth Clients Date of Birth*
Sixth Clients Name

First Name*

Middle Name

Last Name*

Phone*
Sixth Clients Date of Birth*
Seventh Clients Name

First Name*

Middle Name

Last Name*

Phone*
Seventh Clients Date of Birth*
Eighth Clients Name

First Name*

Middle Name

Last Name*

Phone*
Eighth Clients Date of Birth*
Ninth Clients Name

First Name*

Middle Name

Last Name*

Phone*
Ninth Clients Date of Birth*
Tenth Clients Name

First Name*

Middle Name

Last Name*

Phone*
Tenth Clients Date of Birth*
Parent or Guardian's Email Address

Email
A signed copy of this waiver will be sent to the email address you provide.
Type of piercing

Type of piercing being done
Blood born pathogens
Do you have any blood born pathogens , transmitted deseases or recent illnesses? (its ok if you do , we just want to know for everyone's safety*
No
Yes

If answered yes please provide descripton
Risks
By checking yes I understand that prior to being pierced, I will be fully informed of the risks associated with receiving a piercing. I also understand that I am free to ask my piercer about the risks at anytime throughout the process, prior to getting pierced. I understand that these risks , known and unknown, can lead to injury, including , but not limited to infection, scarring , and keloiding and allergic reactions. I still wish to proceed with the piercing and understand that I freely accept all risks that may arise from receiving a piercing**
No
Yes
Release
By checking yes , I choose to waive and release to the fullest extent permitted by law , each piercer and studio from all liability whatsoever, for any and all claims or causes of action that I , my estate , heirs , executers or assigns may have for personal injury or otherwise , including any direct and/or consequently damages , which result or arise from my tattoo , whether caused by negligence or fault of either piercer or the studio**
No
Yes
Questions
By checking yes I understand that both piercer and piercing studio allow me the full opportunity to ask any and all questions about the piercing procedure and they can and will be answered to my total satisfaction**
No
Yes
Aftercare
By checking yes I understand that I will be given proper aftercare instructions prior to receiving a piercing. I acknowledge that it is possible that the piercing can become irritated or infected, particularly if I do not follow instructions given**
No
Yes
Duress
By checkiong yes. I affirm that I am not under the influence of alcohol or drugs and that I am voluntarily receiving a piercing without duress ("duress" n-threats, violence, constraints, or other actions= braught to bear on someone to do something against their will or better judgement)**
No
Yes
Medical conditions
By checking yes, I agree that I DO NOT have diabetes , epilepsy, hemophillia , a heart condition, nor do I take blood thinning medication, I do not have any other condition that may interfere with the application or healing of the tattoo. I am not the recipient of an organ or bone marrow transplant or , if I am I have taken the preventative antibiotics. I am not pregnant or nursing. I do not have a mental impairment that may effect my judgement in getting a piercing**
No
Yes

If answered no please provide description
Permanant change
By checking yes 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-pierced condition even after its removal**
No
Yes
Photography
By checking yes. I agree to 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. If you do not agree, do Not check Yes and please advice your piercer*
No
Yes
The release form
By checking yes. 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**
No
Yes
Covid-19
Please indicate if you have any of the following symptoms today or within the last 14 days
Shortness of breath
Fever
Cough
Chills
Sore throat

Have you been around anyone with these symptoms in the last 14 days? if so please explain

Have you traveled domestically or internationally within the last 4 weeks if so where have you traveled
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.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
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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