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Sky Blue Piercing LLC

Let us do this part

Today's Date:

Fri Jul 25 2025 01:40

Practitioner:*

Please read and answer

Appointment*

What is the date and time for your appointment?

Procedure*

Is your appointment for a jewelry change or piercing? What piercing is it for?

Allergies*

Do you have any allergies?

Details:

Bloodbourne Pathogens*

Do you have any bloodbourne pathogens, transmittable diseases or recent illnesses? (It' okay if you do, we just want to know for our and other's safety).

Details:

Duress*

I affirm that I will not be under the influence of alcohol or drugs for my appointment, and I am voluntarily getting a piercing without duress.

Medical Conditions*

Do you have diabetes, epilepsy, hemophilia, a heart condition, or take blood thinning medication? Do you have any other medical or skin condition that may interfere with the procedure or healing of the piercing? Are you pregnant or nursing? If yes, please describe below.

Details:

Risks*

I understand that there are risks associated with getting a piercing, known and unknown, that can lead to injury, including but not limited to infection, scarring, keloiding, and allergic reactions. I still wish to proceed with the piercing and I freely accept all risks that may arise from getting a piercing.

Release*

I agree TO WAIVE AND RELEASE, to the fullest extent permitted by law, Jay McColm and Sky Blue Piercing, LLC from all liability whatsoever, for 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, whether caused by the negligence or fault of either the Artist or the Piercing Studio, or otherwise.

Attorney Fees*

I agree to reimburse each of the Artist and the Piercing Studio for any attorneys. fees and costs incurred in any legal action I bring against either the Artist or the Piercing Studio and in which either the Artist or the Piercing Studio is the prevailing party.

Photography

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

If any provision, section, subsection, clause or phrase of this release is found to be unenforceable or invalid, that portion shall be severed from this contract. The remainder of this contract will then be construed as though the unenforceable portion had never been contained in this document.

Client Information

I hereby declare that I am of legal age (with valid proof of age) and am competent to sign this Agreement or, if not, that my parent or legal guardian shall sign on my behalf, and that my parent or legal guardian is in complete understanding and concurrence with this agreement.

Legal Name:*

Pronoun:

Chosen name:

Address:*

Postcode:

Date of birth:*

If you are under 18 your parent/guardian will be required

Phone #:*

Email:*

Signature:*

Sign above or type signature:

Photo ID*

Please take photo(s) of your government issued photo IDs and related paperwork.