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Spanish

Déjenos hacer esta parte.
Fecha de hoy:
Mon Jul 14 2025 11:20
Practicante:*
Piercing Name:
Por Favor lea y responda
S
N
Eaten*
Have you eaten in the past 4hrs? It's a good idea to before hand to increase your blood sugar levels.
S
N
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).
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 given me instructions on the care of my 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 I am not under the influence of alcohol or drugs, and I am voluntarily getting a piercing without duress.
Medical Conditions*
I affirm that I do not have diabetes, epilepsy, hemophilia, nor do I have a heart condition or take blood thinning medication. I do not have any other medical or skin condition that may interfere with the procedure or healing of the piercing. I am not the recipient of an organ or bone marrow transplant or, if I am, I have taken the prescribed preventive regimen of anti-biotics that is required by my doctor in advance of any invasive procedure such as piercing. I am not pregnant or nursing.
Permanent change*
I acknowledge that the piercing will result in a permanent change to my appearance and that my 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.
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.
Comments and/or complaints - contact the Southern Nevada Health District, Environmental Health Division. (702) 759-0677 or send written comments to Post Office Box 3902, Las Vegas, NV 89127
Si alguna disposición, sección, subsección, cláusula o frase de este comunicado se considera inaplicable o inválida, esa parte será separada de este contrato. El resto de este contrato se interpretará como si la parte inaplicable nunca hubiera estado contenida en este documento.
Client Information
Por la presente declaro que soy mayor de edad (con prueba válida de edad) y soy competente para firmar este Acuerdo. o, en caso contrario, que mi padre o tutor legal firme en mi nombre, y que mi padre o tutor legal entienda y esté de acuerdo con este acuerdo.
Nombre legal:*
Pronombre:
Chosen name:
Direccion:
Postcode:
Fecha de nacimiento:*
Si tu estas bajo 18 Tu Pariente o guardian legal
Telefono:
Correo Electronico:*
Firma:*


Foto de Identificación*
Por Favor Tome fotografías de sus documentos de identidad con fotografía emitidos por el gobierno y de la documentación relacionada.