I understand that any questions I have about the body piercing procedure will be answered to my satisfaction, and I will be given written aftercare instructions for the piercing I am going to receive. *

I understand that body piercing can result in medical complications such as nerve damage, bone and tooth loss, and that if I choose to remove my jewelry, permanent holes or scars may be left.*

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

I understand there is a possibility of getting an infection and that I will be advised of the signs and symptoms of infection that indicate I need to seek medical attention. *

I agree to follow all instructions concerning the care of my body piercing.*

I understand that there is a chance I might feel lightheaded or dizzy during or after being pierced. I agree to immediately notify the body piercer in the event I feel lightheaded, dizzy and/or faint before, during or after the procedure.*

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

I am the person on the legal ID presented as proof that I am at least 18 years of age.

If I am under the age of 18, I will ensure the piercing is performed in the presence of my parent or legal guardian.*