top of page
HOME
SERVICES
FAQ
Contact US
Pleasure & Pain
Piercing / Tattoo Release Form
Release Form
First name
Last name
Email
Date of Birth
Phone
Address
Are any of conditions applicable to you?
Diabetes
HIV/AIDS
Heart condition
Faint/Dizzy
Hemophilia
Infections
Scarring/Keloiding
Epilepsy
Herpes
Hepatitis
Pregnant/Nursing
Description of piercing / tattoo:
I understand that a piercing is semi-permanent /I understand that tattoos are permanent.
I understand that a piercing / tattoo is a change to my body that may leave a permanent hole or scar.
I agree to follow the piercer’s aftercare instructions while my piercing is healing. I agree that any re-piercing needed, due to my own negligence, will be done at my own expense.
I agree to follow the artists aftercare instructions while my tattoo is healing. I agree that any touch-ups work needed due to my negligence, it will be done at my own expense. This includes sun and ultraviolet frequency damage.
To my knowledge, I do not have 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.
I acknowledge the decision for obtaining my piercing/tattoo is my own free will and choice (no duress/coercion). I consent to the location of the procedure and the performance of the piercing/tattoo procedure. I am not under the influence of alcohol or drugs.
I acknowledge that if my tattoo is a symbol, the tattoo artist and the owner of this business is not responsible for what it may or may not mean. If it’s written in another language, I have confirmed all spelling and grammar.
I agree to notify the piercer/ tattoo artist of any allergies related to the procedure. Pleasure and Pain uses nitrile gloves, alcohol wipes, and implant grade surgical stainless steel. I acknowledge that it is not reasonably possible for the representatives and employees of Pleasure and Pain to dertermine wheter I might have an allergic reaction to the metals, materials, dyes, pigments or processes used in my piercing/tattoo.
I understand there is a always a possibility of getting an infection as a result of receiving a piercing or a tattoo. I will seek medical attention as soon as possible if it occurs.
I acknowledge that I have advised my piercer/tattoo artist of any conditions that might affect the healing of this piercing/tattoo. I do not have medical or skin conditions such as but not limited to: acne, scarring (keloid), eczema, psoriasis, freckles, moles, or sunburn in the area to be tattooed thant may interfere with said tattoo. If I have any type of infection or rash anywhere on my body, I will advise the piercer/tattooer.
I acknowledge and agree to following any and all instructions provided to me regarding the maintenance of a sanitary environment while I am being tattooed/pierced.
DERMALS: I understand that a microdermal is semi-permanent and consists of a pierced point of entry but not a point of exit (single point of exit). Specially designed jewelry is inserted into the pierced area and sits below the skin where it becomes anchored.
I agree to IMMEDIATLY notify the artist if I feel lightheaded, dizzy and/or faint before, during or after the procedure. Failure to do so releases Pleasure and Pain and my tattoo artist of all responsability.
Pleasure and Pain is under 24/7 video surveillance for the safety and security of our staff and clients. I consent to be photographed and video taped while on Pleasure and Pain property.
I hereby release and forever discharge and hold harmless Pleasure and Pain and all affiliates, owners, managers and employees from any and all claims, damages or legal actions arising from or connected in any way with my piercing/ tattoo, or the procedure and conduct used in my piercing/tattoo to the fullest extend allowed by the law.
BY SIGNING BELOW, I AGREE I HAVE READ AND UNDERSTAND THIS PIERCING / TATTOO CONSENT FORM AND AGREE TO ITS TERMS.
Initials
Submit
Thanks for submitting!
PROMOTIONS
bottom of page
