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Piercing Consent Form

Full Name

Address

Date Of Birth

Date Of Piercing

Piercing Placement

Relevant Medical History

Side Of The Body

Right

Left

Centre

Piercing Consent and Medical Declaration

I am not pregnant, nursing, diabetic, epileptic or a haemophiliac.

I do not have a heart condition or any other medical condition that may interfere with the application or healing of the piercing.

I do not take any blood thinning medication.

I do not have HIV or Hepatitis.

I am not under the influence of alcohol or drugs and I am voluntarily submitting to be pierced without duress or coercion.

I am fully aware of the process involved and I understand the importance of adhering strictly to the correct aftercare procedure which is outlined thoroughly in the “aftercare” section of the Impermanence Tatu website.

I understand that if this aftercare advice is not correctly adhered too that infection can happen and if this becomes the case that it could not be the fault of Impermanence Tatu practitioners.

I fully understand that the associated inherent risks of obtaining a piercing, known or unknown can lead to injury, including but not limited to infection, scarring, migration of the jewellery and possible allergic reactions to the metal used.

Having been informed of the potential risks associated with getting my respective piercing, I still wish to continue with the procedure and I freely accept and expressly assume all risks that may arise from my piercing.

I agree to waive Impermanence Tatu from all liability whatsoever for any and all claims or causes of action that I may have for personal injury or otherwise, including any direct or consequential damage that may arise from having my piercing.

I agree that photographs may be taken of my piercing and that images may be used online in a portfolio.

I hereby declare that I am of the required age of 16 or have the consent of an adult and that I am competent to sign this agreement.

Consent

Name Of Consenting Adult

Address Of Consenting Adult

Signing Consent On Behalf of

Signing Consent On Behalf of Myself

Signing Consent On Behalf of A Child