ONLINE PIERCING CONSENT FORM

I hereby acknowledge to obtain a piercing and have been given full opportunity to ask any and all questions I might have about obtaining piercing from Backstage, and all my questions have been answered to my full and total satisfaction. *Please check it here.

Obtaining this piercing is my choice alone and will result a permanent change to my appearance, and that no representation has been made to me as to the ability to later restore the skin involved in this piercing to its pre-piercing conditions. *Please check it here.

It is not reasonably possible for the piercer to determine whether I have an allergic reaction to the piercing or process in the piercing and further acknowledge that such a reaction is possible. *Please check it here.

I will be pierced using appropriate instruments and sterilization techniques *Please check it here.

I have been advised of all the procedures necessary to promote satisfactory healing of my piercing *Please check it here.

Infection is always a possible result of obtaining a piercing, and I agree to follow all the instructions concerning the care of my piercing while it is healing *Please check it here.

I am aware and have been advised of the potential danger oral jewelry may cause to gum and teeth. *Please check it here.

I must consult a health care provider for: unexpected redness, tenderness, swelling , unexpected drainage at the site of the piercing, any rash or a fever within (2) hours of the body art procedure *Please check it here.

Please select your condition below *

I do not have Diabetes

I have Diabetes, and understand that my conditions may hamper the healing process

Please select at least one choice above.

I am not pregnant or nursing *Please check it here.

I do not have Epilepsy or Hemophilia *Please check it here.

I do not have heart conditions or take any medications such as anticoagulants that thin my blood *Please check it here.

I do not have any history of skin diseases or skin conditions such as, but not limited to, Keloids, Hypertrophy scarring, Psoriasis, Lesions or open wounds at the site of the piercing *Please check it here.

I do not have HIV, Hepatitis or any other communicable disease *Please check it here.

I have advised the piercer of any allergies *Please check it here.

I am over the age of 18 *Please check it here.

I am not under the influence of drugs or Alcohol *Please check it here.

I do not have any physical or mental impairment or disabilities, which might affect my well being as a result of my decisions to have a piercing done at this time *Please check it here.

I hereby agree to pierce my body part(s) listed above. I agree that this type of piercing takes 2-6 months or longer to heal. *Please check it here.

I, the customer, therefore agree to release and forever discharge and hold harmless the business Backstage (DAVANTI INC), the piercer and the employees from any and all claims, damages or legal actions related to, in any way, with my piercing, the procedure or conduct in my piercing. *Please check it here.

Customer’s full name: *

Please enter your full name.

Customer’s Signature: *

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Address (street, city, state, zipcode): *Please enter your answer here.

Date of Birth: *

Please enter valid date.

Where exactly do you want to pierce on your body? (ears, nose, etc) *Please enter your answer here.

Phone #: *Please enter your phone number.

Email: Please enter your email.

Emergency Contact Person: Please enter your name.

Emergency Contact Person's Phone Number: Please enter your phone number.

First and last name: Please enter your name.

Address (street, city, state, zipcode): Please enter your answer here.

Your Signature

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Please sign here.

Artist Name: *Please enter your name.

Artist Signature *

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BACKSTAGE Offers PIERCING in New York. Fill this piercing online waiver.

I specifically acknowledge that I have been advised of the following:

I represent to my piercer that:

CONSULT HEALTH CARE PROVIDER FOR:

Unexpected redness, tenderness or swelling at the site of the piercing
Rash
Unexpected drainage at or from the site of the piercing
Fever within 24 hours of the piercing

BACKSTAGE Offers PIERCING in New York. Fill this piercing online waiver.

I specifically acknowledge that I have been advised of the following:

I represent to my piercer that:

CONSULT HEALTH CARE PROVIDER FOR:

Unexpected redness, tenderness or swelling at the site of the piercingRashUnexpected drainage at or from the site of the piercingFever within 24 hours of the piercing

Unexpected redness, tenderness or swelling at the site of the piercing
Rash
Unexpected drainage at or from the site of the piercing
Fever within 24 hours of the piercing