Under 16 Piercing Consent Form

Let us do this part

Today's Date:

Tue Apr 29 2025 03:40

Practitioner:*

Body Piercing Location:*

Jewellery Type:*

Please fill in the Piercing Release Form to the best of your ability. If you have any questions please ask a member of staff.

Please read and answer

MEDICAL*

Do you suffer from or are you receiving medical guidance for any of the following:
- heart disease
-blood disorders (high/low blood pressure)
- hemophilia
-impetigo
-seizures: I.e: epilepsy
-diabetes
-hepatitis (A,B,C)
- HIV/AIDS
-acne
-psoriasis
-keloid scarring

Details:

Are you on any regular drug treatments?
Please let us know if so

Details:

Any allergies? e.g
Adhesive plasters
Alcohol swabs
Allergies to antiseptic and disinfectant agents such as Chloroxylenol
Jewellery
Metal

Details:

EATEN*

Have you eaten a substantial meal or snack in the last 2 hours?

NUMBING AGENTS*

Have you applied any topical numbing creams/lotions?

AFTERCARE/DOWNSIZE*

I agree to follow the aftercare routine given to me during my appointment.
I have answered the above information truthfully and to the best of my ability

I confirm that I am aware of the importance of downsizing my jewellery once the initial swelling has subsided, and that there is an additional cost for this. If longer jewellery is not downsized, it can result in the piercing migrating, rejecting or change the angle.

Please be aware that 14ct/18ct gold attachments are still on a titanium labret for initial piercings. If you are wanting a solid 14ct gold labret for your initial piercing, there is an additional cost. You will still require a downsize for an additional cost.

I do not swim regularly and I do not have any holidays or festivals planned during the healing period of my piercing.

LIABILITY RELEASE*

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

I understand it is my right to withdraw from the Piercing procedure at any time, however I will not be entitled to a refund once the Piercer has set up, as there are set up costs and piercers time incurred. I understand that if I withdraw from the piercing procedure today, I will have to pay again if I choose to go ahead with it in the future.

I can confirm that I have not applied any topical numbing agents to the Piercing site prior to my appointment. Any such numbing agents used in the Piercing area will result in the piercers refusal to perform the Piercing. I will not be eligible for a refund due to set up costs and piercers time.

GDPR*

I understand that my information (data) given on this form will be stored as an electronic copy and will not be stored physically. The information is stored by The Owl and the Pussycat Piercing LTD only and will not be used for marketing purposes or passed on to third parties. By signing our consent form, our clients ackowledge that we are compliant with GDPR regulation and that their information is stored correctly and not passed on

PERMANENT CHANGE*

I acknowledge that the piercing will result in a permanent change to my appearance and that my skin may never return to its pre-piercing condition even after its removal.

PHOTOGRAPHY*

I release all rights to any photographs taken of me and my Piercing and give consent in advance for their reproduction in print or electronic form

DOCUMENTATION*

I confirm that I am over the age of 8 and will provide government issued photo identification to a member of staff when asked to prove my age and date of birth. I confirm that my parent or legal guardian will provide government issued photo identification and proof of guardianship

RULES*

I understand that there is a '3 strike' rule meaning that 3 failed attempts at the piercing will mean that the procedure is stopped and I will not be entitled to a refund due to cost of materials, piercers time etc

I understand that I can change my mind at any point during the procedure, however I will not be entitled to a refund due to cost of materials, piercers time etc

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 16 your parent/guardian will be required

Phone #:*

Email:*

Signature:*

Sign above or type signature: