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Drift piercing studios

Let us do this part

Today's Date:

Thu Dec 26 2024 12:36

Practitioner:*

Body Piercing Location:*

Body Piercing Price:*

jewelry used :*

Artist signature:*

Welcome to Drift !

Please read and answer

Allergies*

I have advised the Piercer of any allergies to metals, latex gloves, soaps, iodine, and/or medications. Please input the allergy you have in the text field. If you have no allergies, please type in N/A. I understand Drift piercing studios is not responsible for any reactions to materials if they are not listed here before hand.

Eaten*

Have you eaten in the past 4hrs? It's a good idea to before hand to increase your blood sugar levels.

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 Drift piercing studios 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 Drift piercing studios, 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.

Emergency Contact *

Please give a name address and phone number for an emergency contact.

Doctor *

Please give the name, address, and phone number of your primary physician

No Refund Policy*

I understand that checking this box that all jewelry sales are final and may not be refunded or returned. under any circumstances.

Metals and Alloys

I understand that Drift piercing studios never uses any jewelry containing nickel content for initial piercing. I understand that that Drift piercing studios only uses the following metals and alloys for initial piercing - Implant grade steel & titanium, 14k gold yellow, rose, and white. our white gold is allowed with palladium a well known hypoallergenic metal. if I am known to be allergic to any of these materials I assure that I have listed in the known allergen box.

No Doctor

I affirm that I do not have a primary care physician. If I require medical care I will taken to the nearest Emergency Room: Advent Health, 601 E Rollins St, Orlando FL, 407-303-5600

Complications

If the client has any complications, the piercer needs to describe the incident and how it was handled below

Gender/Sex*

Race/Ethnicity*

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.