1 Step 1 Beneath The Skin Tattoo PIERCING CONSENT FORM Legal Name Chosen NameIf Applicable Pronouns Date of Birth AddressStreet AddressCity, State AddressZip Code Phone Emailemail Social Media Tag(s) Piercing Type Piercer Price Picture IDuploadcloud_uploadUpload Second ID(if minor)cloud_uploadUpload Please Read and AcknowledgeYou must be 18 years of age and able to provide a valid drivers license, State issued or Military ID with your photo on it. If you are underage, you must have a parent/guardian PRESENT at the time of your piercing.Beneath The Skin Tattoo reserves the right to refuse service to anyone. Example: Anyone under the influence of alcohol or drugs or anyone with an altered ID will not be pierced.Beneath The Skin Tattoo places a limited guarantee on your piercing. Failure to follow the care instructions or damage due to infection, allergic reactions, migrations or improper care voids the guarantee. I agree to follow the simple procedures in the written outline for the care of my piercing for the period recommended in order to reduce the chance of piercing bumps, rejection and infection.I understand that infections are rare but possible and that I should contact a physician should an infection occur.Beneath The Skin Tattoo implements the highest aseptic standards and protective protocols to prevent any exposure to virus and pathogen. I understand that piercing may affect my immune system, thereby making me more susceptible to illness. I ACCEPT THIS RISK. Do you currently have/have you had any of the following illnesses?Check all that applyHepatitisEpilepsyDiabetes. If yes, do you have Dr. consent? YNLiver or Blood disordersCovid-19HIV/AIDS Are you currently taking any medication prescribed by a doctor?YN Type For Are you currently taking any medication NOT prescribed by a doctor?YN Type For Do you have a latex allergy?YN Have you eaten in the last 3-4 hours?YN Are you pregnant or nursing at this time?YN I have read and understand all statements and questions asked on this form and have answered to the best of my knowledge. Furthermore, I will not hold Beneath The Skin Tattoo, its owner(s), employees, consigns or heirs responsible for any false information given by me on this form or for any complication(s) which may occur from this tattoo. SignatureType Full Name DateToday's Datedate_range Submit Form keyboard_arrow_leftPrevious Nextkeyboard_arrow_right FormCraft - WordPress form builder
