Piercing PROCEDURE
CONSENT, RELEASE & WAIVER OF LIABILITY

Please fill out the following form.

Studio: Kiss Of Ink

Artist: Sophie Robbens

Address: 10 Squires Park Shefford Bedfordshire SG17 5FP

Phone: 07807079776

Email: sophiekissofink@gmail.com

First name

Last name

Date of birth

Day

Month

Year

Address

Contact No.*

Emergency Name and Contact No.*

Government Issued Document Type and No.

File upload

Have you been hospitalized in the last 12 months?

Yes

Are you suffering from a medical condition, illness or injury?

Yes

If you answered yes to any of the questions above, please supply additional information.

I certify that:

I am at least 18 years of age, or I meet the legal requirements for piercing in this jurisdiction.
I/minor is over 7 years of age for strictly a lobe piercing.
I/minor is over 16 years of age for a face or body piercing.
I have provided valid government-issued identification.
If I am a minor, a parent or legal guardian is present and has signed the required consent documentation.
I am not under the influence of alcohol or drugs.

I understand that body piercing involves puncturing the skin or cartilage and carries inherent risks, including but not limited to:

Infection
Bleeding
Swelling and bruising
Allergic reactions to metals or cleaning products
Nerve damage (rare)
Scarring or keloids
Jewelry rejection or migration
Prolonged healing

I confirm that I have disclosed any relevant medical conditions, including but not limited to:

Blood disorders or clotting conditions
Heart conditions
Diabetes
Immune disorders
Skin conditions
History of keloids or poor wound healing
Allergies (including metals, latex, antiseptics, etc.)
Pregnancy or nursing status
Use of blood thinners or prescription medications

List any medical conditions or allergies here: ie. Latex (gloves)

I understand and acknowledge that:

Piercing is not without risk and healing times vary by individual and piercing location.
There is no guarantee regarding healing time, jewellery compatibility, or final placement appearance.
Jewellery may need to be downsized or changed during the healing process.
Improper aftercare, trauma, or failure to follow instructions may result in complications.

I acknowledge that:

I have received verbal and/or written aftercare instructions.
Proper aftercare is my responsibility.
Failure to follow aftercare instructions may result in infection, rejection, scarring, or other complications.
The studio and piercer are not responsible for complications arising from improper aftercare or external factors beyond their control.

If I experience signs of infection or unusual symptoms, I agree to seek medical attention promptly.

I confirm that:

I have selected my jewellery voluntarily.
I understand the material type and any associated risks.
I understand that changing jewellery too early may cause complications.

Photography & Marketing Consent

I consent to photographs or videos of my tattoo being taken and used for portfolio, website, and marketing purposes.

I do NOT consent to photographs being used.

To the fullest extent permitted by law, I voluntarily release, discharge, and hold harmless:

Kiss Of Ink, its owners, employees, contractors, artists, and affiliates

from any and all claims, liabilities, damages, losses, or expenses arising out of or related to the tattoo procedure, including but not limited to personal injury, infection, allergic reaction, dissatisfaction with artistic outcome, or other complications, except in cases of gross negligence or willful misconduct where prohibited by law.

I understand that I am assuming all risks associated with this procedure.

For health and safety reasons, all rashes or open wounds must be fully covered before entering the studio. KOI reserves the right to refuse entry or decline procedures if this policy is not followed.

I have read this entire document carefully. I understand its contents and sign it voluntarily. I acknowledge that I have had the opportunity to ask questions and that all questions have been answered to my satisfaction.

Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Print Name *

I am a Parent/Guardian

Date Signed

Date

Day

Month

Year

I declare that the info I’ve provided is accurate and complete.

Payment Methods

- Credit / Debit Cards
- PAYPAL

- Offline Payments

Piercing PROCEDURE CONSENT, RELEASE & WAIVER OF LIABILITY

Payment Methods

Piercing PROCEDURE
CONSENT, RELEASE & WAIVER OF LIABILITY