Piercing Consent Form

Health Declaration

Please read & fill out the entire form.

This is an agreement between the piercer and the client, indicating that full communication has taken place to ensure a legal, safe, and successful body piercing.

First Name

Last Name

Gender/ Pronoun

Today's Date

Phone

Date of Birth

Emergency Contact (Name & Number)

Address

Session Description

Meddications

Allergies

Health Conditions & STD's

Statements Of Consent

I have truthfully represented to Amonara Creations that I am over 18 years of age or have my parent/ guardians consent.

I have eaten within the past 4 hours.

I have not drank alcohol within the past 8 hours.

If I have provided my own jewelry, I take full responsibility for how my body reacts with the metal.

I understand my piercer cannot be held responsible if my body reacts negatively to the metal of the jewelry.

I understand that my piercer's suggestions are not medical advice.

I understand I am responsible for looking after my piercing.

I understand sterilized jewelry and equipment and/ or single use disposables will be used for my piercing.

This is to certify that I, the above named and undersigned, do give my permission to be pierced at Amonara Creations.

I am fully away of and take full responsibility for the piercing process, the healing, and the daily aftercare procedure.

By signing this form, I agree to the statements of consent & that all information is truthful and accurate.

Your Signature

Identification

Please upload a copy of your ID.

Upload supported file (Max 15MB)

Identification

Other Form of ID (If Applicable)

Upload supported file (Max 15MB)

Identification

Parent/ Guardian's ID

Upload supported file (Max 15MB)

Piercers Signature

Piercers Notes

Parent/ Guardians Signature (If Applicable)

Thanks for submitting!

Piercing Consent Form

Health Declaration

Statements Of Consent

​