Minor Pierceing Consent Form | Naked Face Spa LLC

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Minor Child Piercing Release

I

the parent/legal guardian of

induce

to pierce my son's/daughter's________ and in considerations of its doing so, I hereby release NAKED FACE SPA & COSMETICS and its employees and agents, from all manner of liabilities, claims, actions and demands, in law or in equity, which I or my heirs have or might have now or hereafter by reason of complying with my request to be pierced.

I FULLY UNDERSTAND THAT ANY EMPLOYEE or agent of NAKED FACE SPA & COSMETICS , when performing body piercing, does not act in the capacity of a medical professional. The suggestions made by any employee or agent of NAKED FACE SPA & COSMETICS, are just suggestions. They are not to be construed as or substituted for advice from a medical professional.

I understand my SON/DAUGHTER WILL BE PIERCED using appropriate instruments and techniques. To ensure proper healing of the piercing, we agree to follow the aftercare procedures outlined in the aftercare Instructions" sheet, until healing is complete. I understand that this type of piercing usually takes_____________ or longer to heal.

BY MY SIGNATURE BELOW, I certify that I am the parent/legal guardian of _________________ who is at least___________ years old, and also willingly submits to these procedures, with a full understanding of possible complications such as but not limited to infection, allergic reaction, or rejection of the piercing.

MY SON/DAUGHTER AND I HAVE RECEIVED A COPY OF THE "AFTERCARE INSTRUCTIONS'' SHEET, which we have read and fully understand and hereby assume full responsibility for aftercare and cleanliness for my son/daughter. I understand that by having this piercing performed my son/daughter is making a permanent change to his/her body and no claims haxie been made regarding the ability to undo the changes made

Have you eaten with the last 4 hours?

Yes

No

Have you have any alcoholic beverages in the last 8 hours?

Yes

No

Are you prone to fainting?

Yes

No

Are you prone to heavy bleeding?

Yes

No

Have you taken aspirin, ibuprofen or anticoagulants with in the last 24 hour

Yes

No

Have you have any allergies?

Yes

No

If yes, please list

Are you pregnant?

Yes

No

Do you have any conditions which might affect the healing of this piercing?

Yes

No

How did you hear about

Friend/ Relative

Repeat Customer

Phone Book

Online

Other

Name

Telephone

Address

Email

City, State & ZIP

By my signature below I certify that I am the parent or leta,a1 guardian of the above named person . I Further understand that if I gave False information or produce false documents stating my name and age to be other than correct, then I am liable for prosecution.

Minor Signature (Piercee)

Select a date

Age

Signature

Date

Age

Piercee:

Photo ID/Type

Jewelry Inserted

Fees

Jewelrys

Number

Salt$

Satin$

Date of Birth

Tech 2000$

I acknowledge that the sterilization procedures used were explained to my full satisfaction and f had the opportunity to ask any question regarding these procedures. Both written and verbal aftercare instructions were provided to me,

Piercee Initials

Client Initials

Day of Week

Time of Day

Thanks for submitting!

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Naked Face Cosmetic Spa is devoted to awakening a fresh perspective towards the external appearance and illuminating the beauty of bare skin through the intentional and skillful use of industry leading skincare & cosmetic treatments.

Founded by Haley Blanding.

Full body and Face Tattooing, Permanent Makeup, Medical and Restorative Tattooing, Tattoo Removal, Piercings &

Spa Spa Services

Spa Location: 10025 Lakewood Drive SW, STE B Lakewood, WA 98499

Tattoo Location: 11120 Gravelly Lake Drive SW STE 10

Lakewood, WA 98499

© 2022 Naked Face Spa Cosmetic. | Establishes in 2018

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