Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

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Todays Date *

MM

DD

YYYY

I have been fully informed of the inherent risks associated with getting a piercing and I fully understand these risks. *

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I WAIVE AND RELEASE to the fullest extent permitted by law any person of the Tattoo Studio from all liability whatsoever, including but not limited to, any and all claims or causes of action that I, my estate, heirs, executors or assigns * may have for personal injury or otherwise, including any direct and/or consequential damages, which result or arise from the procedure and application of my piercing, whether caused by the negligence or fault of either the Tattoo Studio, or otherwise. *

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I do not suffer from diabetes, epilepsy, hemophilia, heart condition(s), nor do I take blood thinning medication such as anticoagulants, which interfere with blood clotting. *

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I do not have a history of epilepsy, seizures, fainting or narcolepsy. *

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I do not have any other medical or skin condition that may interfere with the procedure, application or healing of the piercing. *

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I am not pregnant or nursing *

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I do not have a mental impairment that may affect my judgement in getting the piercing. *

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Skinworks Tattoo Studio has given me the full opportunity to ask any question about the procedure and application of my piercing and all of my questions, if any, have been answered to my total satisfaction. *

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I release the right to any photographs taken of me and the piercing and give consent in advance to their reproduction in print or electronic form *

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I acknowledge that I have been given adequate opportunity to read and understand this document and that I am signing a legal contract waiving certain rights to recover damages against the Tattoo Studio *

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Skinworks Tattoo Studio has given me instructions on the care of my piercing while it's healing. I understand and will follow them. *

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I am not under the influence of alcohol or drugs, and I am voluntarily submitting to be pierced by the Tattoo Studio without duress or coercion *

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I HAVE READ THE AGREEMENT, I UNDERSTAND IT, AND I AGREE TO BE BOUND BY IT. *

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I hereby declare that I am of legal age (and have provided valid proof of age and identification) and am competent to sign this Agreement. *

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