←

Body Piercing

Let us do this part

Today's Date:

Sun Dec 8 2024 06:22

Body Piercing Location:*

Artist signature:*

Please read and answer

Jewellery Type

Titanium

Are you the Client or Parent/Guardian*

I will provide valid photo id*

Can you provided a birth certificate or legal document confirming your relationship to the client?*

Do you consent to the body piercing procedure (or on behalf of the minor under your guardianship)?*

Do you have ANY Cold / Flu symptoms?*

IF YOU HAVE:
- a cold
- a fever
- flu-like symptoms
- shortness of breath
- change in sense of smell or taste
- cough
- sore throat

WE NEED YOU TO NOTIFY A STAFF MEMBER.

Have you had Contact with anyone with Covid Symptoms in last 15 days?*

-High Temperature
-Flu-like symptoms
-Shortness of breath
-Change in sense of smell or taste

Details:

Do you suffer from any of the following Medical Conditions?*

-Heart Condition/Angina
-Blood Pressure Problems
-Epilepsy/Seizures
-Haemophillia/Blood Clotting Disorders
-Skin Complaints
-Diabetes
-Allergic Response
-Prone to Fainting Attacks
-Regularly Take Blood Thinning Medicines
-Could you be Pregnant?
-Are you a Nursing Mother?
-Any other Medical Condition?

Details:

Bloodbourne Pathogens*

Do you have any bloodbourne pathogens, transmittable diseases or recent illnesses?

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.

Waiver*

TO WAIVE AND RELEASE to the fullest extent permitted by law each of the Piercer and the 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 from my tattoo, whether caused by the negligence or fault of either the Piercer or the Tattoo Studio, or otherwise.

Healing*

I understand that after care instructions, on the care of my piercing while it's healing, are available via the website www.valhallastudio.co.uk
I have had the chance to read 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 given to me.
If any re-piercing or removal is needed due to my own negligence, I agree that the work will be done at my own expense.

Influence*

I will not attend my appointment under the influence of alcohol or drugs, and I am voluntarily submitting to be pierced without duress or coercion.

Health*

I do not have diabetes, epilepsy, hemophilia, a heart condition, nor do I take blood thinning medication or have made the operator aware and have checked with my GP.
I do not have any other condition that may interfere with the application 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 preventive anti-biotics.
I am not pregnant or nursing.
I do not have a mental impairment that may affect my judgment in getting the piercing.

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.

Legal*

I agree to reimburse each of the Piercer and the Tattoo Studio for any solicitors fees and costs incurred in any legal action I bring against either the Piercer or the Tattoo Studio and in which either the Piercer or the Tattoo Studio is the prevailing party.
I agree that the that the courts in Scotland shall have personal jurisdiction and venue over me and shall have exclusive jurisdiction for the purpose of litigating any dispute arising out of or related to this agreement.

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 you do not tick this provision, please advise your Piercer).

Questions*

I acknowledge that I have been given adequate opportunity to read and understand this document, that any and all of my questions have been answered, that it was not presented to me at the last minute, and I understand that I am signing a legal contract waiving certain rights to recover against the Piercer and the Tattoo Studio.

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.

Name:*

Address:*

Postcode:

Date of birth:*

If you are under 16 your parent/guardian will be required

Phone #:*

Email:*

Signature:*

Sign above or type signature:

Emergency Contact

If something happens, your emergency contact might need to explain your medical history, allergies, or medications.

Name:

Phone #:

Photo ID*

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