Minor Piercing Consent

Adults Full Name *

Adults Phone *

Adults Email *

Upload or Take a Photo of your ID with your Phone

Adult ID *

Minor Full Name *

Minor ID Upload *

Minor ID

Another Form Of ID for minor

Adult Address *

City *

State *

Zip code *

Date of birth *

If you have been diagnosed or suspect that you have Hepatitis, HIV/AIDS or any STD please consult your physician before having any invasive procedure. The healing process following a tattoo, piercing or laser removal can compromise your immune system. Please inform your artist if you have any of these conditions. This is for your protection as well as ours. Thank you for your cooperation.

Please check the following that apply to the person receiving piercing, if none leave blank

Emergency Contact First Name *

Emergency Contact Last Name *

Emergency Contact Number *

Also, while The TATTOO DEMO NAME uses only industry standard pigments & materials, there could be an allergic reaction. Tattoos and Body Piercings are an invasive procedure in which the skin is penetrated by a foreign object. This may cause discomfort, pain, scarring, bleeding, swelling, the risk of infection, possibility or nerve damage & can increase this risk for adolescents during certain stages of development. Anesthesia cannot be legally made available by the person performing the procedure unless such person holds the appropriate license from a TATTOO LOCATION State health board. If proper sterilization and antiseptic procedures are not followed by the artist there is a risk of transmission of any and all blood borne pathogens and other infections. I understand that should the artist experience a needle stick or similar injury from instruments used to perform my procedure, that I could be required to provide a venous blood sample to a health department representative for testing for the presence of any and all infectious diseases. I understand that photos may or may not be taken of the work performed. Any media become the property of TATTOO DEMO NAME to use as they see fit. This is including but not limited to any character likeness, voice or situational representation that may result in profit.

I understand that without the proper use of aftercare TATTOO DEMO NAME will not guarantee any service provided and that an "touch up" will be done solely at the artist discretion. I also understand that my guarantee only pertains to the need for a "touch up" and not a "rework". Differentiating between the two will be solely at the artist discretion. Neglect of my service in any way voids any and all guarantees. New Aftercare Must be purchased at time of touch-up. No exceptions will be made. There are no refunds of any monies paid. Store credit is at the sole discretion of TATTOO DEMO NAME

Adult Signature *

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Artist/Staff Signature *

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