Loading...

PIERCING CONSENT FORM


I ACKNOWLEDGE THE FOLLOWING STATEMENTS:

  • I understand I am undergoing a piercing treatment. All piercing materials are single-use that are pre-packaged, sealed and sterilized.
  • If I am taking blood thinning medications or antibiotics, if I have diabetes, if I am pregnant or have a history of infection or any other medical condition, I acknowledge that the piercing may carry a risk and I must consult a physician for approval before piercings .
  • I understand that despite the best efforts of piercing artist and my own aftercare efforts, the potential for infection exists. Improper aftercare, poor hygiene, metal sensitivity or other causes, may increase the risk of infection. 
  • I understand that piercing may contribute to the formation of cysts or keloids.
  • I have read and understand the PIERCING AFTERCARE INSTRUCTIONS and I will receive a copy for my reference. 
  • I understand that Beauty Realm LLC., is unable to monitor my at-home aftercare, therefore it is my sole responsibility to follow the -PIERCING AFTERCARE INSTRUCTIONS provided at the time of piercing.
  • l have agreed to this piercing procedure and I am fully aware of the potential risks and complications. 

Initial here:


PIERCING RELEASE OF LIABILITY & CLAIM WAIVER

  • Beauty Realm LLC., and its Artist follow a safe and hygienic piercing protocol. However, improper core of newly pierced ears on my behalf or due to other causes can result in problems outside of their control. I, 'the undersigned, acknowledge that piercing carries some risks. These risks include but are not limited to infection, metal sensitivity, allergic reactions, inflammation, embedded earrings, scarring, fainting and other complications.
  • I understand that Beauty Realm LLC., and its body artist, when performing piercing procedures, do not act in the capacity of medical professionals. The recommendations made by the piercing specialist are recommendations only. They are not to be construed as, or taken as medical advice.
  • I voluntarily agree to this piercing procedure, for myself or for a minor in my care, and I am fully aware of the potential risks and complications. In addition, I hereby assume all risks of loss or injury of any kind whatsoever that may be associated with this piercing procedure.
  • By signing this PIERCING Release OF LIABILITY AND Claim WAIVER, I hereby acknowledge and represent the following:
  • I have read and understand this PIERCING RELEASE OF LIABILITY AND CLAIM WAIVER and sign it voluntarily.
  • I am at least I8 years old and hold myself liable in respect to this  piercing procedure. I hereby release liability on behalf of Beauty Realm LLC., and their affiliates and waive any future claims against them.
  • I understand I must be 18 years old or older to have my ears and/or cartilage, nose, and naval pierced and my signature below confirms my acknowledgment. I realize this applies to first time piercings and consecutive piercings. I understand I must show proof of age by presenting some form of identification.
  • I am the parent or legal guardian of a minor under the age of I8 and hold myself liable in respect to this ear piercing procedure. I hereby release liability on behalf of Beauty Realm LLC., and their affiliates and waive any future claims against them.
  • For purposes of signing this PIERCING Release OF LIABILITY AND CLAIM WAIVER, I understand that it is fraudulent for a minor to represent herself/himself as an adult and/or to falsely represent oneself as a parent or legal guardian. 

Initial here:


PIERCING AFTERCARE INSTRUCTIONS AGREEMENT

I understand that I must carefully follow all PIERCING AFTERCARE INSTRUCTIONS and hereby release Beauty Realm LLC., and its Artists from any and all claims that I may have as a result of myfailure to follow all PIERCING AFTERCARE INSTRUCTIONS. 

Initial here:


EAR PIERCING AFTERCARE INSTRUCTIONS 

  • With clean hands, apply Aftercare Solution to the front & back of each piercing site Two -Three times per day. While cleansing, gently slide your earrings back & forth and rotate them in a circle only once. This will ensure absorption of the solution at the piercing site. For STUDEX Advanced Aftercare products, follow the instructions on the bottle. DO NOT REMOVE YOUR EARRINGS WHEN CLEANSING.
  • DO NOT TIGHTEN your earring backs.
  • Use care when using products like shampoo, soap, hair dye, perfume and hairspray near your ears. If possible, gently cover your piercing to avoid contact with these products. If contact occurs, rinse your ears immediately to avoid irritation.
  • Use care when styling your hair around your newly pierced ears. Brushes, combs, curling irons and hair dryers and even clothing should be kept a safe distance from your piercing. 
  • Use care while dressing. Pulling clothes over your head can result in trauma to your ears and slow the healing process.
  • Avoid swimming. If you must swim, cleanse your ears with aftercare products immediately.
  • Avoid over-the-ear headphones, hats, caps and scarves that rest at ear level.
  • For earlobe piercing, leave your new earrings in for SIX WEEKS. For cartilage piercing, leave your new earrings in for TWELVE WEEKS. After this time, provided your ears are completely healed, you may replace your earrings with another pair. DO NOT wear heavy earrings for at least 4 months to prevent stretching. If your ears begin to feel sore, return to your original earrings for 1-2 MORE WEEKS and resume the aftercare instructions.
  • Pain, redness and/or swelling are not normal reactions to ear piercing and are generally uncommon. Please consult a physician IMMEDIATELY. To reduce the risk of irritation, choose earrings that are made with surgical steel, 14 gold, titanium or stainless steel.  


Piercing Recipient Signature:

If you are under 18, the signature of a parent or legal guardian is required 

Date: June 23, 2025


First Ear Piercing Recipient's Name
First Name*
Middle Name
Last Name*
First Ear Piercing Recipient's Age Acknowledgment*
First Ear Piercing Recipient's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
First Ear Piercing Recipient's Signature*
Second Ear Piercing Recipient's Name
First Name*
Middle Name
Last Name*
Ear Piercing Recipient's Date of Birth*
Date of Birth
Third Ear Piercing Recipient's Name
First Name*
Middle Name
Last Name*
Ear Piercing Recipient's Date of Birth*
Date of Birth
Fourth Ear Piercing Recipient's Name
First Name*
Middle Name
Last Name*
Ear Piercing Recipient's Date of Birth*
Date of Birth
Fifth Ear Piercing Recipient's Name
First Name*
Middle Name
Last Name*
Ear Piercing Recipient's Date of Birth*
Date of Birth
Sixth Ear Piercing Recipient's Name
First Name*
Middle Name
Last Name*
Ear Piercing Recipient's Date of Birth*
Date of Birth
Seventh Ear Piercing Recipient's Name
First Name*
Middle Name
Last Name*
Ear Piercing Recipient's Date of Birth*
Date of Birth
Eighth Ear Piercing Recipient's Name
First Name*
Middle Name
Last Name*
Ear Piercing Recipient's Date of Birth*
Date of Birth
Ninth Ear Piercing Recipient's Name
First Name*
Middle Name
Last Name*
Ear Piercing Recipient's Date of Birth*
Date of Birth
Tenth Ear Piercing Recipient's Name
First Name*
Middle Name
Last Name*
Ear Piercing Recipient's Date of Birth*
Date of Birth
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*
Middle Name
Last Name*
Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
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!