←

Elaira Consent & Waiver Form

Let us do this part
Today's Date:
Wed Jan 22 2025 10:59
Practitioner:*
Type of Piercing:*
Elaira Consent & Waiver Form
Please read and answer
Please Read & Check Box*
I hereby release the piercer and Elaira Sdn Bhd from all manner of liabilities, claims, actions and demands in law, or in
equity, which I or my heirs might now or hereafter by reason of complying with my request to be pierced. I fully
understand that the body piercer, in performing a piercing, does not act in the capacity of a medical professional. The
suggestions made by the piercer should not to be construed as, or substituted for, advice from a medical professional. I
understand that infection/ irritations can occur due to lack proper hygiene and/or metal sensitivities. I also understand
that this piercing may leave noticeable, permanent scarring. To ensure proper healing of my piercing, I agree to follow
the aftercare procedures suggested by the piercer.
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:*
Chosen name:
Address:
Postcode:
Date of birth:*
If you are under 18 your parent/guardian will be required
Gender:
Phone #:*
Email:*
Sign up for our newsletter
Signature:*


Emergency Contact
If something happens, your emergency contact might need to explain your medical history, allergies, or medications.
Name:
Phone #:*