Loading...

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 low 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 jewerly inserted/removed. Aftercare instructions 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 presecution. 

Today's Date: December 21, 2024


Please select who will be participating...
AdultMinor
Continue
First Participant's Name

First Name*

Last Name*

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

Area(s) pierced

How old is this / these piercing(s)?

Piercing Initially Performed at
Do you have any allergies to Latex?*
No
Yes
First 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*
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*

Relationship*

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

Area(s) pierced

How old is this / these piercing(s)?

Piercing Initially Performed at
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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!