I HAVE CONTRACTED WITH ROYAL KIDD ON THE ABOVE DATE TO PIERCE THE PIERCING TYPE AND LOCATION STATED ABOVE & ALL BELOW.
I UNDERSTAND THERE ARE CERTAIN RISKS ASSOCIATED WITH HAVING THE ABOVE PARTS OF MYSELF PIERCED AND THAT THE RISKS MAY INCLUDE BUT ARE NOT LIMITED TO INFECTION, ALLERGIC REACTION, SCARRING, OR OTHER PROBLEMS THAT ARISE WHERE MEDICAL ATTENTION MAY BE REQUIRED. IN THE EVENT THAT MEDICAL ATTENTION OR ANY OTHER CARE BECOMES NECESSARY, I ASSUME ALL RESPONSIBILITY FOR SAID TREATMENT.I AGREE TO NOT HOLD ROYAL KIDD, ITS EMPLOYEES, AGENTS, PROMOTERS, ANY PERSON PROVIDING SPACE TO ROYALL KIDD OR ASSOCIATED WITH ROYAL KIDD IN ANY WAY RESPONSIBLE, AND EXEMPT THE SAME FROM ANY AND ALL LAWSUITS. I STATE UNDER PENALTY OF PERJURY LAWS THAT I AM OVER THE AGE OF 18 AND THAT MY ID DOCUMENTS ARE MY OWN AND HAVE NOT BEEN ALTERED. I FURTHER STATE THAT I AM NOT UNDER THE INFLUENCE OF DRUGS AND/OR ALCOHOL. AND THAT I HAVE NOT ENGAGED IN HEAVY CONSUMPTION OF ALCOHOL THE NIGHT PRIOR TO THE DAY OF MY PROCEDURE. I HAVE INFORMED ROYAL KIDD OF ANY MEDICAL CONDITIONS I MAY HAVE, FURTHER, I WILL DISCLOSE ANY MEDICATIONS TO ROYAL KIDD THAT I AM CURRENTLY TAKING THAT MAY CONTRIBUTE TO BLEEDING O HEALING PROBLEMS.
PARENTAL CONSENT
I DO HEREBY GIVE PERMISSION TO ROYAL KIDD TO PERFORM THE FOLLOWING PIERCING(S) LISTED ABOVE I ALSO STATE THAT I HAVE READ AND UNDERSTAND ALL THE INFORMATION ON THIS FORM AND AGREE TO THE SAME, ALL TERMS AND CONDITIONS.
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