Date of your piercing appointment:*

Date

Full Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Birth Date*

MonthDayYear

Pronouns:

E-mail*

Please read through and select "yes" or "correct" to acknowledge that you have read and agree to our terms:

RISKS:

I, the undersigned, acknowledge that I have been informed of the potential risks involved with body piercing, including but not limited to: infection, scarring, allergic reaction to jewelry or materials. prolonged healing. I agree to follow the aftercare instructions provided to minimize these risks. I understand that failure to follow proper aftercare may result in complications.*

yes

GUESTS:

While a brief stay in the waiting area is possible for a guest, it's crucial to emphasize that this area is primarily designated for client-artist consultations and provides a space for necessary breaks. Please refrain from bringing guests unless absolutely necessary.

yes

Traveling clients: If you do not live within the Vancouver Coastal Health region, we ask that you respect whatever the suggested Provincial Health travel restrictions are during the date of your appointment. Please make sure to check the BC Gov website at least 2 weeks prior to your travel plans to know what the restrictions are. Contact us as soon as possible if your appointment will be affected by these advisories.

I am aware of any travel restrictions that may affect my appointment

QUESTIONS & AFTERCARE:

Both the Piercer and Liquid Amber Tattoo have given me the full opportunity to ask any and all questions about the application of my piercing. PLEASE NOTE: You will have time on the day of your appointment to go over any additional questions*

yes

The Piercer and Liquid Amber Tattoo have given me instructions on how to care for my piercing while it’s healing. I understand these instructions and will do my very best to follow them. I acknowledge that it is possible that the piercing can become infected, particularly if I do not follow the instructions given to me. (See link below for thorough aftercare instructions)*

yes

Aftercare instructions: https://www.liquidambertattoo.com/piercing-aftercare

ALCOHOL AND DRUGS:

During my piercing session, I will not be under the influence of alcohol or drugs, and I am voluntarily submitting to be pierced by the Piercer without duress or coercion.*

correctOther

HEALTH CONDITIONS:

Please check any of the following conditions that apply to you and/or elaborate further below.*

I do not have any other medical or skin conditions that I have not listed above that may interfere with the application or healing of the piercing. I am not pregnant or nursing. I do not have a mental impairment that may affect my judgment in getting the piercing*

correctOther

PHOTOS:

I release all rights to any photographs taken of me and the piercer and give consent in advance to their reproduction in print or electronic form. Please note: If you check no on this provision, please advise and remind your piercer and Liquid Amber Tattoo staff to not to take any pictures of you and your completed tattoo.*

yesno

LIABILITY:

If any provision, section, subsection, clause or phrase of this release is found to be unenforceable or invalid, that portion shall be severed from this contract. The remainder of this contract will then be construed as though the unenforceable portion had never been contained in this document.

If legal age is required for the certain service I am getting, I hereby declare that I am of legal age (and have provided or will provide valid proof of age on the day of my service) and am competent to sign this Agreement.

I waive and release Liquid Amber Tattoo, its staff, and practitioners from all liability for any claims or damages arising from my piercing, including those caused by negligence, to the fullest extent permitted by law.*

yes

I acknowledge that I have been given adequate opportunity to read and understand this document, and I understand that I am signing a legal contract waiving certain rights to recover against the practitioner and Liquid Amber Tattoo.*

yes

Signature*

Piercing Consent & Release Form