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Cambridge Jewelry Change Form

Don't forget to bring government issued photo ID with you to your appointment, its required!

 

 

Release Form 

For Piercing Assessment, Stretching, Insertion, or Removal 

By signing this form, I induce Lucky's Tattoo & Piercing to STRETCH or ASSESS my previous piercing, or to INSERT or REMOVE jewelry into/from my previous piercing, and in consideration of doing so, I hereby release Lucky's Tattoo and Piercing and its employees and agents, from all manner of liabilities, claims, actions and demands, in law or in equity, which I or my heirs have or might have now or hereafter by reason of complying with my request to have my piercing assessed, stretched, or to have my jewelry inserted/removed. Aftercare available at http://www.luckystattoo.org/piercing-aftercare


By my signature below, I give permission for said insertion/removal/stretching/assessment and I further understand that if I give false information or produce false documents stating my name and age to be other than correct, then I am liable for prosecution. 

Today's Date: October 23, 2024

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

Piercing(s) we are changing today

How old are piercings we are changing?

Was this piercing done at Lucky's?
Do you have any allergies to Latex?*
No
Yes
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

Piercing(s) we are changing today

How old are piercings we are changing?

Was this piercing done at Lucky's?
Do you have any allergies to Latex?*
No
Yes
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

Piercing(s) we are changing today

How old are piercings we are changing?

Was this piercing done at Lucky's?
Do you have any allergies to Latex?*
No
Yes
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

Piercing(s) we are changing today

How old are piercings we are changing?

Was this piercing done at Lucky's?
Do you have any allergies to Latex?*
No
Yes
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

Piercing(s) we are changing today

How old are piercings we are changing?

Was this piercing done at Lucky's?
Do you have any allergies to Latex?*
No
Yes
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

Piercing(s) we are changing today

How old are piercings we are changing?

Was this piercing done at Lucky's?
Do you have any allergies to Latex?*
No
Yes
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

Piercing(s) we are changing today

How old are piercings we are changing?

Was this piercing done at Lucky's?
Do you have any allergies to Latex?*
No
Yes
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

Piercing(s) we are changing today

How old are piercings we are changing?

Was this piercing done at Lucky's?
Do you have any allergies to Latex?*
No
Yes
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

Piercing(s) we are changing today

How old are piercings we are changing?

Was this piercing done at Lucky's?
Do you have any allergies to Latex?*
No
Yes
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

Piercing(s) we are changing today

How old are piercings we are changing?

Was this piercing done at Lucky's?
Do you have any allergies to Latex?*
No
Yes
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*
Check to receive information, news, and discounts by e-mail.
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*

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

Piercing(s) we are changing today

How old are piercings we are changing?

Was this piercing done at Lucky's?
Do you have any allergies to Latex?*
No
Yes
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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