⇠
Jewelry Change
Let us do this part
Today's Date:
Mon Nov 2 2026 03:19
Jewelry change location?:*
I acknowledge by signing this agreement that I have been given the full opportunity to ask any and all questions which I might have about the changing of my jewelry and that all of my questions have been answered to my full satisfaction. I specifically acknowledge I have been advised of the facts and matters set forth below and I agree as follows:
Please read and answer
Y
N
Are you currently pregnant or nursing.
Y
N
Do you have epilepsy or hemophilia? Do you suffer from any heart
conditions or take medication which thins the blood? Do you have any conditions
such as diabetes that might affect your healing?
Y
N
Do you suffer from any other communicable or bloodborne diseases that may affect your healing?
Y
N
Do you suffer from medical or skin conditions such as, but not limited to: keloid or hypertrophic
scarring, psoriasis at the site of the piercing or any open wounds, infections, rashes, or lesions at
the site of the piercing?
Y
N
Do you have any allergies to metals, latex, soaps, iodine or medications?

Details: 
I have trustfully represented to the piercer that, to my knowledge, I do not have any physical, mental or medical impairment or disability which might affect my well-being as a direct or indirect result of my decision.
I affirm that I am not under the influence of alcohol or drugs, and I am voluntarily getting a jewelry change without duress.
I affirm that I am getting this jewelry change of my own free will and am not being forced to do so.
I acknowledge infection is always possible as a result of changing jewelry before a piercing is healed. I have received aftercare instructions and agree to follow all of them.
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.
I hereby release and forever discharge and hold harmless Paige Holloway the piercer and all affiliates, Owners, Managers, and Employees from any and all claims, damages or legal actions arising from or connected in any way with my piercing, or the procedure and conduct used in my piercing, to the fullest extent allowed by the law. I specifically acknowledge I have been advised of the facts and matters set forth above and I agree. Therefore I hereby release and forever discharge and hold harmless Hollow Hands Body Art and all affiliates, owners, managers, and employees from any and all claims, damages or legal actions to the fullest extent allowed by the law. I certify under Penalty of Perjury that the above information is true and correct.
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.
Legal Name:*
Pronouns:
Chosen name:
Address:*
Postcode:*
Date of birth:*
 
Age: 
Phone #:*
Email:*
Signature:*