Piercing release form

Your Name

Are you HIV positive? (required)

Do you have hepatitis? (required)

Are you hemophiliac? (required)

Are you prone to fainting? (required)

Are you pregnant? (required)

Have you consumed alcohol in the past 8 hours? (required)

Are you an intravenous drug user? (required)

Do you have any allergies? (required)

Are you epileptic? (do you have seizures?) (required)

Are you taking any medications? (required)

Do you have low blood sugar? (required)

What type of piercing do you want? (required)

How did you find us (required)

To have Jewels32 pierce me, and in consideration of doing so, I hereby release Jewels32, its employees, and its agents from all manner of liabilities, claims, actions and demands in law or in equity, which I, or my heirs, have no or hereafter by reason of my complying with my request to be pierced. I understand that I will be pierced using appropriate instruments and techniques to ensure proper healing for my piercing. I agree to follow the procedures outlined in the Jewels32 aftercare instructions until healing is complete. I'm informed and agree with time of full healing process. I acknowledge that I am at least 18 years old, or that I am the legal guardian of the person to be pierced. I acknowledge that all the information above is correct to best of my knowledge and by signing: I confirm that the above is true.*