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Piercing Terms Form

TERMS OF ENGAGEMENT FOR BODY PIERCING

This page is only to be submitted upon a booking confirmation.  Call us on 095291405 or request appointment here before subitting this form. You can also fill in this form instore upon appointment.  By filling and submitting this form you agree to the terms of engagement set by Fuschia Boutique as below and upon your body piercing appointment. 

PLEASE FILL IN YOUR DETAILS read & sign

Date of Booking:

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Full Name:

Date of Birth:

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Phone:
Address:
Email:

Piercing:

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If not on the list please state:

RELEVANT HEALTH INFORMATION

If you have any of the following please tick:

HIV
Hepatitis
Haemophilia
Allergies

If anything else please state:

DO YOU AGREE TO OUR TERMS:

• All individuals under the age of 18 must have parent or guardian consent (see below).

•I have advised staff at Fuschia of any medical condition or allergy that might affect this piercing in any way.

•I acknowledge that this piercing is being performed under strictly sterile conditions, using appropriate equipment and techniques and I agree to follow the procedures outlined in the aftercare form until the piercing is completely healed.

• Furthermore, I understand that infection can occur due to improper hygiene if the aftercare procedures are not followed.

•Not withstanding that Fuschia has taken all reasonable steps to ensure that the piercing is performed safely. I acknowledge that in the unlikely event of infection or other complications occurring, I hereby release Fuschia from any liability, claims and damages resulting directly or indirectly from this piercing.

•I declare that I have read this release form and record that I understand it and agree to be legally bound by it.

I Agree

PARENTAL CONSENT

LEAVE BLANK if you are 16 + for nose, navel/belly and ear piercings. All other piercings require age 18+ WITH ID/OR parental consent as below. ID WILL BE REQUIRED AS NECESSARY UPON APPOINTMENT IF WITHOUT CONSENT.

Parent/Guardian Consent Given by :
Relationship to Person Named Above:
Phone: