CONSENT TO PIERCING PROCEDURE
RELEASE AND WAVER OF ALL CLAIMS
Operators are required to collect certain personally identifiable information for the purpose of determining
procedural eligibility. Completion of this form is not required by statutory reference. Services will not be provided without the completion of this form. I acknowledge by signing this Release that I have been given full opportunity to ask any and all questions that I might have about obtaining a Piercing and that all my questions have been answered to my full satisfaction. I specifically acknowledge that I have been advised of the facts and matters set forth below and I agree as follows:
1) If I have diabetes, epilepsy, hepatitis, hemophilia, HIV-AIDS or any other communicable disease,
heart condition or I take medication that thins the blood, I have advised my Piercer. I am not pregnant or nursing. I am not under the influence of alcohol or drugs.
2) I do not have medical 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 my piercing.
3) I acknowledge it is not reasonably possible for the employees of THE NEXUS TATTOO STUDIO
to determine if I might have an allergic reaction to the piercings or processes used in the piercings, and I agree to accept the risk that such a reaction is possible.
4) 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 tattoo. I have received aftercare suggestions and agree to care for my piercing to the best of my ability.
5) A Parent or Legal Gaurdian must be present for any Minors to get pierced and both parties must provide proper identification to the Piercer. No Exceptions.
6) Minors must be able to verbally consent to the piercings, as well as physically complete their name on the release form.
7) I acknowledge that a piercing can be a permanent change to my appearance. To my knowledge, I do not have any physical, mental or medical impairment or disability that might affect my well being as a
direct or indirect result of my decision to have a tattoo.
8) I have truthfully represented to THE NEXUS TATTOO STUDIO that I am at least 18 years of age
and that obtaining a piercing is by my choice alone, for myself or for a Minor whom I am of legal guardianship.
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Therefore, I request the application of a piercing. I agree to release and forever discharge and hold harmless
THE NEXUS TATTOO STUDIO, and all employees from any and all claims, damages or legal actions
arising from or connected in any way to my piercing or the procedure and conduct used in the application of my piercing.