Parent/Guardian Name *

First Name

Last Name

Client (Minor's) Name *

First Name

Last Name

Preferred Name of Minor

First Name

Last Name

Parent/Guardian Date of Birth *

MM

DD

YYYY

Client (Minor's) Date of Birth *

MM

DD

YYYY

Parent/Guardian Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Client (Minor's) Address

if different from parent/guardian

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian Phone *

(###)

###

####

Client (Minor's) Phone *

(###)

###

####

Please consent if under 18 *

I acknowledge I am under the age of eighteen and that I have truthfully represented to the piercing team and Babydoll Tattoos that the obtaining of a piercing is by my choice alone with my parent/guardian's legal consent. I consent to the execution of the piercing, and to any actions or conduct of the representatives and employees of the tattoo shop reasonably necessary to perform the piercing procedure.

Yes

No

Parent/Guardian - Please Consent *

I acknowledge I am over the age of eighteen and that I have truthfully represented to the piercing team and Babydoll Tattoos that the obtaining of a piercing is by my child/ward's choice alone. I consent to the execution of the piercing on their behalf, and to any actions or conduct of the representatives and employees of the tattoo shop reasonably necessary to perform the piercing procedure.

Yes

No

1. Please Read Thoroughly *

If I have any condition that might affect the healing of 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.

Parent/Guardian - Yes

Parent/Guardian - No

Client (Minor) - Yes

Client (Minor) - 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 my 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.

Parent/Guardian - Yes

Parent/Guardian - No

Client (Minor) - Yes

Client (Minor) - No

3. Please Read Thoroughly *

I do not have medical or skin conditions such as nut 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.

Parent/Guardian - Yes

Parent/Guardian - No

Client (Minor) - Yes

Client (Minor) - 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.

Parent/Guardian - Yes

Parent/Guardian - No

Client (Minor) - Yes

Client (Minor) - 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.

Parent/Guardian - Yes

Parent/Guardian - No

Child/Minor - Yes

Child (Minor) - 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.

Parent/Guardian - Yes

Parent/Guardian - No

Client (Minor) - Yes

Client (Minor) - 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.

Parent/Guardian - Yes

Parent/Guardian - No

Client (Minor) - Yes

Client (Minor) - No

8. Please Read Thoroughly *

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

Parent/Guardian - Yes

Parent/Guardian - No

Client (Minor) - Yes

Client (Minor) - No

9. 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.

Parent/Guardian - Yes

Parent/Guardian - No

Client (Minor) - Yes

Client (Minor) - No

10. 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.

Parent/Guardian - Yes

Parent/Guardian - No

Client (Minor) - Yes

Client (Minor) - No