Piercing Release Form printable pdf download

ARTISTIC IMPRESSIONS

PIERCING RELEASE

Over 18

Name: ________________________________________________________ Date:_______________________

Address: ____________________________ City:_________________ State: __________Zip:________________

Phone #:____________________________ Email: __________________________________________________

DL#: ____________________________ DOB: ____________________ Age:______________________

M / F

If Not using DL, Type of identification: ____________________________________________________________

I hereby declare that I am of the legal age of 18 years or older, and have provided valid proof of age. I agree to allow the

Artist and Artistic Impressions to obtain a copy of my driver’s license and/or ID.

Signature: _____________________________________________________ Date: ______________________________

1.) What is the Piercing(s) you will be receiving?:______________________________________________________

2.) Was the type of jewelry explained to you? Y / N

3.) Do you agree with the jewelry that will be used for your piercing? Y / N

I state that both the piercer and Artistic Impressions have given me full opportunity to ask any and all questions

regarding my piercing and the piercing procedure. All of my questions have been answered to my satisfaction and I

agree completely to the piercing that I will be receiving. I understand that a piercing is a change to my appearance and

could possibly leave a scar if removed or taken out. I release all rights to any photographs taken of me or my piercing to

the Artist and Artistic Impressions and give consent in advance to their reproduction in print or electronic form. I fully

understand that a piercing is an art and not a science, anything that can go wrong, could go wrong. I understand that all

fees and payments for my piercing are non-refundable. I agree that the courts of Texas in Harris County shall have

personal jurisdiction and venue over me and shall have exclusive jurisdiction for the purpose of litigation and dispute

arising out of or related to this agreement. I agree to waive and release to the fullest extent permitted by law both the

piercer and Artistic Impressions from all liability whatsoever, for any and all claims or causes of action that I, my estate,

heirs, executors, and or assigns may have for full personal injury or otherwise, including my direct and or consequential

damages, which result or arise from the application of my piercing, whether caused by the negligence or fault of the

piercer or Artistic Impressions or otherwise. I agree to leave the premises of Artistic Impressions Studio promptly upon

request, for any reason whatsoever, by any agent, artist or employee of Artistic Impressions Studio. I acknowledge that I

have been given adequate opportunity to read and understand this full document, and that it was not presented to me

at the last minute. I understand that I am signing a legal contract waiving certain rights to recover against the Artist and

Artistic Impressions Studio. I have read this agreement, understand it, and agree to be bound by it.

Signature:_________________________________________________________ Date:___________________________

1.) Have you been to Artistic Impressions before? Y / N

2.) Would you like to be added to our email list? Y / N

3.) How did you hear about us? :____________________________________________________________________

PLEASE TURN FORM OVER

OFFICE USE ONLY

Piercer:____________________________ Location:_______________________ Ticket:________________________

Description of Piercing:_______________________________________ Jewelry Used: _________________________

Piercing Release Form