I ____ allow for ______ to be pierced and in considerations of it doing so, I hereby release _____ and its employees and agents, from all liability by reason of complying with my request to be pierced. I FULLY UNDERSTAND THAT ANY EMPLOYEE or agent of _____ , when performing body piercing, does not act in the capacity of a medical professional. The suggestions made by any employee or agent of _______ are just suggestions. They are not to be construed as or substituted for advice from a medical professional.
MINOR CHILD PIERCING RELEASE
I UNDERSTAND MY ______ WILL BE PIERCED using appropriate instruments and techniques. To ensure proper healing of my piercing, I agree to follow the aftercare procedures outlined in the “Aftercare Instructions” sheet, until healing is complete.
MY _____ 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 ____ . I understand that by having this piercing performed my ______ is making a permanent change to _____ body and no claims have been made regarding the ability to undo the changes made.
BY MY SIGNATURE BELOW, I certify that I am the _____ of _____ , who is at least ____ years old, and also willingly submits to these procedures, with a full understanding of complications such as but not limited to infection, allergic reaction, or rejection of the piercing.
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