Name *

First Name

Last Name

Preferred Name

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

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Please consent if 18+ *

I acknowledge I am over the age of eighteen and that I have truthfully represented to my piercer and Babydoll Tattoos that the obtaining of a piercing is by my choice alone. I consent to the application of the piercing and to any actions or conduct of the representatives and employees of the tattoo/piercing shop reasonably necessary to perform the piercing procedure.

Yes

No

1. Please Read Thoroughly *

If I have any condition that might affect this piercing, including but not limited to: heart disease, seizures, diabetes, skin disorders, infections or blood conditions; I will advise my piercer. I am not pregnant or nursing. I am not under the influence of alcohol or drugs.

Yes

No

2. Please Read Thoroughly *

I have advised my piercer of any allergies to metals, latex gloves, soaps and medications. I acknowledge it is not reasonably possible for the piercer to determine whether I might have an allergic reaction to the piercing or processes involved in the piercing and further acknowledge that such a reaction is possible.

Yes

No

3. Please Read Thoroughly *

I do not have medical or skin conditions such as but not limited to: acne, scarring (Keloid) eczema, psoriasis, freckles, moles or sunburn in the area to be pierced that may interfere with said piercing. If I have any type of infection or rash anywhere on my body, I will advise my piercer.

Yes

No

4. Please Read Thoroughly *

I acknowledge it is not reasonably possible for the representatives and employees of this tattoo/piercing shop to determine whether I might have an allergic reaction to products used during and after the piercing procedure (including jewelry), and I agree to accept the risk that such a reaction is possible.

Yes

No

5. Please Read Thoroughly *

I acknowledge that infection is always possible as a result of obtaining a piercing - particularly in the event that I do not take proper care of my piercing. I have received aftercare instructions and I agree to follow them while my piercing is healing. I agree that any touch-up work needed, due to my own negligence, will be done at my own expense.

Yes

No

6. Please Read Thoroughly *

I realize that slight variations in placement/appearance of my piercing as selected by me and as ultimately applied to my body. I understand that any scarring, pigmentation changes in the area, or any other changes to the region of the piercing are possible and are my responsibility.

Yes

No

7. Please Read Thoroughly *

I acknowledge that a piercing is a permanent change to my appearance and that no representations have been made to me as to the ability to erase all trace of said piercing despite removing it or letting the skin grow over. To my knowledge, I do not have a physical, mental or medical impairment or disability which might affect my well-being as a direct or indirect result of my decision to have a piercing.

Yes

No

8. Please Read Thoroughly *

I acknowledge that I will be pierced using appropriate instruments and sterilization.

Yes

No

9. Please Read Thoroughly *

I acknowledge I am over the age of eighteen and that I have truthfully represented to my piercer and Babydoll Tattoos that the obtaining of a piercing is by my choice alone. I consent to the application of the piercing and to any actions or conduct of the representatives and employees of the tattoo/piercing shop reasonably necessary to perform the piercing procedure.

Yes

No

10. Please Read Thoroughly *

I acknowledge that once I consent to the placement of the piercing as marked by my piercer, I am agreeing this placement and understand that it cannot be moved without removing the piercing, healing the area and re-piercing the spot. I acknowledge that this is not always possible and will properly examine the placement of the piercing as marked before consenting to moving forward in the process.

Yes

No

11. Please Read Thoroughly *

I acknowledge that certain piercings (namely those in the genital region) include touching of an intimate nature and I consent to my piercer performing their tasks with gloves and in a professional and considerate manner. I acknowledge that if I am choosing to receive a piercing in an intimate spot, my piercer is required to examine, touch and pierce said spot as part of the process.

Yes

No