Piercing Consent Release Forms

If you are interested in scheduling MULTIPLE CLIENTS during the same visit, please have each person book their own appointments if you have any questions. Please direct message me on Instagram

@PiercedByCambria

First Name *

Last Name *

Email *

Phone *

Message

This Booking Is For a Single Person

If you are interested in scheduling MULTIPLE CLIENTS during the same visit, please have each person book their own appointments if you have any questions. Please Direct Message Me on Instagram

@PiercedByCambria

Age Requirements

I want to provide the best experience for all of my client's and I welcome those age of 3 MONTHs & older to get pierced.

All clients that are SEVENTEEN & under will be required to have their parent/ legal guardian present with them during the whole duration at the time of the appointment.

These are the details that are required for documentation.

Everything will be listed below

For those that are younger and getting pierced for the first time, I will make sure i do a consultation at the start of the appointment while going over jewelry options.

This is to utilize the time to get an idea of the child's demeanor and if they are truly ready to get pierced.

If the child, parent, and piercer agree, then we will move forward with the piercing that day.

If the child is crying, shying and hiding behind the parent or show any other signs that they may not be ready at this specific time, we will then hold off on doing the piercing and move to a future date.

At the end of the day, I want it to be a positive experience for everyone involved, but especially the minors getting pierced for the first time!

Required Identification & Whats Accepted

Please note: you will be required to upload the supporting documentation as explained below prior to finalizing your appointment.

Clients 18+ will be required to upload their photo ID which clearly states their date of birth (State ID, Driver's License, Passport, etc.).

Clients 17 & under (Minors), MUST HAVE a parent present with them at the time of the appointment AND will be required to upload the following documentation with

MATCHING LAST NAMES: 1) A photo ID from the parent

(2) A photo ID for the child being pierced (ex. passport, state issued non-driver IDs, School IDs /school portal photo, etc.

If last names DO NOT MATCH, a birth certificate will be required to be uploaded along with the Parents ID and Minors below, and in some cases a marriage license may be needed as well.

Placement Consent

Please Note that during appointment time you will talk to the artist and agree upon Placement for your piercing.

Once agreed and you leave the facility it is no longer at fault to the artist, if there are questions and concerns please reach out to the artist otherwise it will/ cannot be resolved

1. Please sign that you agree to placement. *

Clear

Pricing and Upgrades

Prices listed are STARTING PRICES, which includes the standard surgical grade stainless steel studs/ hoops/ barbells, etc. , along with the piercing.

The price increases if you decide to upgrade your jewelry. Upgrades can range from about $5-$30 more depending on the jewelry.

Upgrades can include, but are not limited to, Implant Grade Titanium, Opals, Diamonds, Clusters, Etc.

I also have solid gold options which will be priced accordingly.

I will go over all of your jewelry options with you at the time of the appointment or consultation.

This Piercing Release Form must be completed for all clients getting pierced at Ethereal Adornments Piercing

Parent/ Legal Guardian of Minor (age 3 Months -17 Years):

I am the parent or legal guardian of the minor being pierced and agree that I will assume all responsibility for any medical, legal, or other situation resulting from my request to pierce my child.

I understand that I will need to remain in the presence of my child during the piercing service.

I understand that my child will be pierced using appropriate instruments and techniques.

2. I agree and consent to the contents above.

Clear

Clients that are 18+

I acknowledge that I have truthfully represented to the artist and/or representative at Ethereal Adornments Piercing that I am at least eighteen (18) years of age and that I am the person on the legal ID presented as proof for my age and identification.

I am not under the influence of alcohol and/or drugs and that I am voluntarily submitting to body piercing without duress or coercion.

3. I agree and consent to the contents above.

Clear

The following sections need to be completed for ALL clients getting pierced.

What to expect for your piercing

A body piercing is when the piercer uses a needle to break the skin and insert jewelry into the perforated tissue. A piercing is a permanent change to your body, that includes scarring to the tissue, possibility of the channel closing if jewelry is removed.Depending on the area of the body that is being pierced, tissue of various types will be perforated, (for example the cartilage of the ear, mucous membrane and muscle of the tongue, the skin above the navel, etc.)With initial piercings, you can expect bleeding, swelling, tenderness, and/or bruising, which are normal. During healing, it is common for some discoloration, itching, secretion of whitish-yellow fluid that will form crust around the jewelry. Proper care of piercings include the following:Wash the piercing with a mild antimicrobial soap once a day, and to flush and irrigate with a saline solution every day, until the piercing is healed.Some swelling, occasional bleeding, bruising, itching, and secretion are common with initial piercings.Avoid until healed: submerging the piercing in any body of water, touching with unclean hands, animal contact, removing jewelry, harsh products that can break down tissue such as(rubbing alcohol, hydrogen peroxide, Neosporin, Bactine, Etc.).Signs and symptoms of infection or when you should seek medical care include: Redness, tenderness of the piercing site, and purulent drainage from the procedure as well as an excessive amount of swelling coming from the site, and/ or bleeding, large amounts of discharge, green/brown/dark yellow discharge, red streaks coming from piercing site, fever, chills, and/or foul odor.If there are signs of infection, please contact your piercer before seeking medical attention.Those signs will be mentioned above!

I agree to make sure I/ they will follow all instructions concerning the care of the piercing.

I understand there is a possibility of an allergic reaction to the jewelry inserted into the fresh body piercing.

I acknowledge that I/ my child getting pierced is free of communicable disease.

I acknowledge that I/ my child getting pierced is not pregnant.

I acknowledge there is a chance I/ my child may feel lightheaded and/or dizzy, during and/or after being pierced and agree I/ they will notify the piercer in the event I/ they feel any of these symptoms.

I understand that body piercings can result in nerve damage, bone and/or tooth loss (depending on the location of the piercing), and that if I/ they choose to remove the jewelry, permanent holes or scars may be left.

I have been fully informed of the risks of the piercing, including, but not limited to infection, other medical complications, scarring, allergic reactions to the jewelry used, latex gloves, and antibiotics. Having been informed of the potential risks associated with receiving a body piercing, I still wish to proceed with the service for myself/ my child and I assume any and all risks that may arise from the body piercing.

I agree to release and forever discharge and forever hold harmless the artist and/or representatives at Ethereal Adornments Piercing from any and all claims, damages, or legal actions arising from or connected in any way with my/ my child's piercing or the procedures and conduct used to perform the piercing,

4. I understand and agree to the content above. *

Clear

Medical History Questionnaire

5. Checkbox *

AIDS
Allergic reaction to latex
Allergic reaction to antibiotics
Anemic
Any form of hepatitis
Astma
Cardiac heart disease
Diabetes
Dizziness
Eczema/ Psoriasis
Epilepsy
Fainting
Gonorrhea
Heart Condition(s)
Hemophilia or other bleeding disorders
Herpes
HIV
HPV
Keloding
MRSA
Pregnant/Nursing
Scarring
Skin Conditions
Sephilis
Taking Blood Thinners
TB
N/A Non Applicable

6. Do you/they have any allergies to Isopropyl alcohol (rubbing alcohol)? *

7. Do you/ they use any medications that might affect the healing of the procedure you'll be getting done? *

8. Do you/ they have any other medical or skin condions that may affect the outcome of the procedure you'll be getting? *

9. Do you/ they have a history of medications use or currently using medication, including being proscribed antibiotics prior to dental or surgery? *

10. Are there any other medical or health conditions that we should be aware of? *

I agree to the terms and conditions

Attachments *

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Attachments

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Supported format: JPG, JPEG, PNG, GIF, SVG.

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Attachments

Choose file or drag here

Supported format: JPG, JPEG, PNG, GIF, SVG.

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Thanks for getting in touch!

We appreciate you for booking an appointment with Ethereal Adornments, we are a small studio that takes pride in the quality of care and services!

Have a great day! We will see you soon!

Thanks for getting in touch!

We appreciate you for booking an appointment with Ethereal Adornments, we are a small studio that takes pride in the quality of care and services!

Have a great day! We will see you soon!

Consultation/Jewelry Change

Consultation/Jewelry Change