Underage Piercing Waiver

Black Cloud Tattoo & Piercing CONSENT TO PIERCE & RELEASE OF ANY CLAIMS.

I acknowledge by signing this Release that I have been given the full opportunity to ask any and all questions which I might have about obtaining a piercing or jewelry change for my child/minor from the Piercing Tech present at Black Cloud Piercing and Body Jewelry and all my questions have been answered by the staff/associates of this establishment.

Store Location*

Phone Number*

Parent/Guardian Full Name*

Parent/Guardian Date of Birth:*

Full Address (Street, City, State, Zip Code):*

Relationship to Minor*

Minors Name:*

Minors Date of Birth:*

*My child/minoris at least 4 months old and/or has been through their second round of shots. (Arguably an ideal time because it coincides with the first round of vaccinations and second round, including the tetanus vaccine.)I agree that my child/minor has the right to refuse to receive a piercing.If my child/minor shows signs of objections several times during the piercing procedure I Agree to let her finish up the procedure at a time when she is more comfortable (may be later during that same day or another day) willing to participate willingly. (Any forcing of the child may result in INJURY to themselves and our Piercers/Techs.) (Typically we only charge partial services if the minor does not participate at the present time, allowing them to come back when then and willingly ready.)By Checking this box I agree to take full responsibility for the cleaning/healing of the minor I am signing for to receive services from Black Cloud Tattoo & Piercing. (The American Academy of Pediatrics (AAP) says there's little risk at any age if the piercing is performed carefully and cared for conscientiously. But the AAP does recommend waiting until a child is old enough to take care of the piercing themselves.)I have been provided with all information describing the body piercing procedure to be performed. I acknowledge that giving consent for my child/minor receiving services/piercing is my choice alone and I have consulted with my physician prior to receiving any piercing/service to assure their health. I acknowledge a piercing is a perforation and will result in a permanent change in appearance, and that no representation has been made to me as to the ability to restore the skin involved in this piercing to is pre-piercing condition.I agree my child/minor does not have any condition that might affect the healing of this piercing, He/She does not suffer from any medical or skin conditions such as, but not limited to: keloid or hypertrophic scarring, psoriasis at the site of the piercing or any open wounds or lesions at the site of the piercing. He/She does not have epilepsy, AIDS, HIV; he/she does not have hepatitis, or other contagious medical conditions; he/she is not a hemophiliac (bleeder) and he/she does not take blood thinners; he/she does not have a heart condition.I understand my child/minor will be pierced using appropriate single use needles, disposables, surgical stainless steel 316L medical grade instruments and that the establishment is enrolled in a periodically endo-spore testing and acquired certificates with an unbiased laboratory. The piercer has been adequately trained by professionals and acquired certificates from bloodborne pathogen institutes and other first aid care programs. We Do Not Pierce with a piercing gun for sanitary and health reasons.I have truthfully represented to Black Cloud Piercing and Body Jewelry and its associates I am the parent or guardian to the personn being rendered services. I attest that I am not using a false Identification to receive services. I am not under the influence of drugs or alcohol. To my knowledge, I do not have any physical, mental or medical impairment or disability which might affect my well-being as a direct or indirect result of my decision to have a piercing done at this time. I have read and understood each of the above paragraphs and I have been given a chance to translate this release form in any language or form of my understanding.I understand all aftercare instructions given to me verbal and/or in written form (online: blackcloudtattoousa.com). Therefore I release Black Cloud Piercing and Body Jewelry (SVS, Inc.) from all if any claim that may result from my child's/minor's care of the piercing/service.I agree to release and forever discharge and hold harmless the Piercer and all staff of Strategic Venture Solutions Inc. dba Black Cloud Piercing and Body Jewelry from any and all claims, damages or legal actions arising from or connected in any way with my childs/minors piercing, or the procedure and conduct used in my piercing. I agree to pay for any and all damages, court cost, attorney representing Strategic Venture Solutions Inc. or injuries to any and all persons and property of SVS, Inc. belonging to SVS, Inc., or any other person to whom SVS, Inc. and representatives may become liable contractually or by operation of law, caused by, or resulting from my decision to have any piercing-related work done by a representative of SVS, Inc.

Date*

Your Electronic Signature*