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Body Piercing Waiver/Consent

I acknowledge that by signing this Consent/Release, I have been given the full opportunity to ask any questions which I might have about obtaining a piercing from She Pierced It (SPI) and that all my questions have been answered to my total satisfaction. I acknowledge I have been advised of the matters set forth below and I agree as follows:

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


2. I do not suffer from any medical or skin conditions such as, but not limited to: keloids, hypertrophic scarring, psoriasis at the site of the piercing, or any open wounds or lesions at the site of the piercing. If I've had any of the above, I will inform my piercer.


 

3. I have advised the Piercer of any allergies to metals, latex gloves, soaps and medications, etc. 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.


4. I have truthfully represented to the Piercer that I am over the age of 18 years (or have proper consent and documentation from my legal guardian/parent). 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.


5. 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 restore later the skin involved in this piercing to its pre-piercing condition.


6. I acknowledge infection is always possible as a result of obtaining a piercing. I have received aftercare instructions and agree to follow them while my piercing heals. I acknowledge that my piercing is my responsibility and I will reach out for assistance if needed via the avenues given in my aftercare packet.


7. I understand I will be pierced using appropriate instruments, jewelry, and sterilization based on my anatomy.


8. I have been offered an aftercare solution or a cleaning alternative to keep my piercing clean and infection-free.


9. I understand that services are non-refundable. I acknowledge that once I leave the shop, my piercing is my responsibility. I will fully describe my needs and desires to my piercer to achieve the best result.


 

First Participant's Name
First Name*
Middle Name
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
First Participant's Signature*
Second Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Second Participant's Signature*
Third Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Signature*
Fourth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Signature*
Fifth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Signature*
Sixth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Signature*
Seventh Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Signature*
Eighth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Signature*
Ninth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Signature*
Tenth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Signature*
Parent or Guardian's Email Address
Email*
Confirm Email*
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Parent or Guardian's Driver's License / ID Card
Driver's License / ID Card Number*
Issuing State*
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*
Relationship*
Phone*
Parent or Guardian's Date of Birth*
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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