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Little Lobe Piercing

Let us do this part
Today's Date:
Fri Aug 15 2025 10:33
Practitioner:*
Piercing Name:*
Body Piercing Price:*
Artist signature:*


Please read and answer
Shop Policies*
Thank you for choosing Inksmith Piercing! Please read the following policies and procedures before proceeding with the paperwork:

For any children 12 and under we will need a parent or legal guardian PRESENT with proper identification. We will also need some sort of identification linking the parent/guardian to the child. Ex: Birth certificate, passport, legal guardianship paperwork.

We will not allow any unattended minors in the shop or in the piercing rooms during a procedure. All minors must be supervised by another adult at all times while in the piercing studio.

Children may have a maximum of 2 adults in the piercing room. All other guests may wait patiently in other areas of the studio.

We do not allow any from of videography during a procedure, pictures are welcome.

Please check the box if you have read and understand this section. If you have any questions or concerns please alert a member of the Inksmith staff immediately. We hope you enjoy your visit!
Y
N
Flu-like symptoms*
IF YOUR CHILD HAS:
- a fever
- flu-like symptoms
- shortness of breath

YOU NEED TO NOTIFY A STAFF MEMBER IMMEDIATELY.
 
How did you hear about us?
 
Y
N
Eaten*
Has your child eaten in the past 4 hours? If not, please inform your piercer.
Y
N
Bloodbourne Pathogens*
Does your child have any bloodborne pathogens, transmittable diseases or recent illnesses? (It's okay if they do, we just want to know for our and other's safety). If you feel comfortable enough to do so, please notify staff. Thank you!
Details:
 
Risks*
That I have been fully informed of the risks, associated with getting a piercing. I understand that these risks, known and unknown, can lead to injury, including but not limited to infection, scarring and keloiding and allergic reactions. Having been informed of the potential risks associated with getting a piercing, I still wish to proceed with the piercing and I freely accept all risks that may arise from piercing.
Release*
TO WAIVE AND RELEASE to the fullest extent permitted by law each of the Artist and the Piercing Studio 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.
Questions*
That both the Artist and the Piercing Studio have given me the full opportunity to ask any and all questions about the piercing procedure and the they have been answered to my total satisfaction.
Aftercare*
I affirm that I have been/will be given instructions on the care of my child's piercing while it's healing, and I understand them and will follow them. I acknowledge that it is possible that the piercing can become infected, particularly if I do not follow the instructions.
Duress*
I affirm that my child is not under the influence of alcohol or drugs, and they are voluntarily getting a piercing without duress.
Y
N
Medical Conditions*
If your child has diabetes, epilepsy, hemophilia, a heart condition, or take blood thinning medication. If your child has any medical or skin condition that may interfere with the procedure or healing of the piercing. If your child is a recipient of an organ or bone marrow transplant, and have or have not taken the prescribed preventive regime of antibiotics that is required by their doctor in advance of any invasive procedure such as a piercing. If they are pregnant or nursing. If yes, please elaborate. Also alert your artist. Thank you!
Details:
 
Permanent change*
I acknowledge that the piercing will result in a permanent change to my child's appearance and that their skin may not be restored to its pre-piercing condition even after its removal.
This Document*
I acknowledge that I have been given adequate opportunity to read and understand this document, that it was not presented to me at the last minute, and I understand that I am signing a legal contract.
Y
N
Photography*
I release all rights to any photographs taken of my child and the piercing and give consent in advance to their reproduction in print or electronic form. If you would like to deny the rights to any photography, please advise your artist beforehand.
Y
N
Physical conditions*
Does your child have any physical conditions that will make piercing them difficult or impossible? (Unable to sit, lay down, etc.)
Details:
 
 
Accomodations
Inksmith Piercing welcomes all members of the neuro diverse community. If your child requires/prefers any specific form of environment, care, or communication please let us know so we can accommodate accordingly.
 
Swimming/Submerging*
I acknowledge that I will not submerge my piercing into any bodies of water for at least two weeks (i.e., pools, lakes, bathtubs, hot tubs, waterparks, etc.) Showering is okay!
Extra Minor Policy
Any child who has NOT been pierced in our studio and is under the age of 10 will require an adult to supervise them if their sibling and/or parent is being pierced or getting jewelry changed. This is for safety and to provide a great experience for the person getting pierced.
A copy of the completed paperwork and aftercare instructions will be sent to the email address provided in the personal info section of this form.

PLEASE NOTE: Paperwork and ID is required for every visit with us. Please come prepared!
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:*


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