Body Piercing Consent Form Choose Your Piercing Medical Information Contact Information & Consent Terms & Conditions What's Next Phone Please make sure you have your Appointment Date & Time and your Deposit Order Number to hand whilst completing this form You are required to complete this Body Piercing Consent Form. If you haven't already booked an appointment, you will need to do this first as you will need to include your deposit number in your consent form. Please complete your consent form before your appointed time. By filling out this form, you consent that the information you have provided in this consent form is true to the best of your knowledge and that you are not under the influence of alcohol or drugs. You also confirm that you have requested this body piercing of your own free will. Email Address * I hereby declare that I give me full consent to Tribal Voice (Please select a store location) * Plymouth Torquay Please Be Aware - Choosing multiple piercing areas in close proximity that are prone to movement and swelling, may be refused and is not advised. This will effect your healing time. - We will confirm the number and type of piercings suitable for you, during your appointment. I understand that the quantity and location of my piercings will be confirmed on the day of my appointment. Piercing Agreement * Which piercing would you like? (Max. 3 per appointment) * Ear Piercing (Scaffold/Industrial or Top Orbital = 2 piercings) Facial Piercing (Incl. Nose & Septum) Oral Piercing Body Piercing (Incl. Genitals) By answering this question, you understand that the piercing will be carried out under hygienic conditions, using the appropriate sterile instruments (including pre-sterilised single-use needles), jewellery and techniques. Please state chosen piercing(s) * If you are unsure of the piercings name, state the approximate location(s) Medical Information We ask these questions for your saftey and so we can be aware of any potential problems during and after the piercing has been carried out. For exmple: people with low immune systems will take longer to heal - we can give a more tailored aftercare based on the info you give us. Do you suffer from any heart conditions or seizures eg: Epilepsy? * Yes No Do you suffer from Haemophilia? * Yes No Do you suffer from Haemorrhaging or bruise easily? * Yes No Do you suffer from immune-compromising conditions? * Yes No Do you suffer from High Blood Pressure? * Yes No Do you suffer from Diabetes? * Yes No Do you suffer from allergic responses to adhesive plasters, creams, metals, iodine, latex or wheatgerm? * Yes No Will you have taken blood thinning medication* eg: Aspirin in the last 24 hours before attending your appointment? * Yes No *A Doctor's Note may be required for ongoing medication Will you have taken any recreational drugs or consumed alcohol in the last 24 hours before attending your appointment? * Yes No *A Doctor's Note may be required for ongoing medication. Are you pregnant or a nursing mother? * Yes No Are you prone to fainting or dizziness? * Yes No Are you prone to swelling? * Yes No If you have swollen excessively in the past its good for us to know before we pierce you so we can accommodate the jewellery Will you have slept well in the last 24 hours before attending your appointment? * Yes No We do not advise attending an appointment after a Night-Shift, please organise your appointment accordingly. Do you agree to eat a full meal within 4 hours before attending your appointment? * I Agree DON'T FORGET! Please note we will not be able to accept this application unless you eat a full-meal within 4 hrs before your appointment. We hold the right to refuse on the day & you will loose your appointment slot. Contact Information & Consent By completing this section: - I confirm that all of the information provided to you in the Consent Form is correct to the best of my knowledge. - I confirm I am not under the influence of alcohol or drugs. - I confirm I have requested this body piercing of my own free will. First Name * Surname * Address * Postcode * Contact Number * Age * Date Of Birth * Terms & Conditions By completing this form: - I confirm that I am neither taking any medication nor suffering from an illness, condition or allergy that hasn't already been stated. Which as a reasonable person I should be aware may react adversely to or be aggravated by a body piercing. I understand that a new piercing is susceptible to infection until healed and that proper aftercare of the piercings site, once I leave the studio, is my responsibility. - I confirm that I will be given the aftercare procedure via email, and that it will be explained to me at the end of my appointment and that I will understand it before leaving. I also confirm that I will follow that aftercare procedure until the healing process is complete. - I understand that notwithstanding the hygienic condition and sterile instruments, jewellery and techniques used by this piercing establishment, there are associated risks with piercing which include infection, scarring, allergic reactions, localised swelling, jewellery embedding and that the piercing may grow out. - In giving this consent I release this piercing establishment, and its employees from all liabilities, actions and demands which I may have now, or in the future, for any loss or damage suffered how ever caused as a result of my piercing (including as a result of a fraudulent misstatement, or in respect of a personal injury caused by myself, my own negligence or any failure on my part to follow the aftercare procedures). I agree with the stated Terms & Conditions * Covid-19 Update* If you are unwell or have tested positive please let us know. We can reschedule your appointment but we will need at least 24 hours notice. *We have the right to refuse anyone, under our own discretion, no matter the reason. Covid-19 Liability Waiver - I acknowledge the contagious nature of the Coronavirus/COVID-19. - I further acknowledge that Tribal Voice has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19. - I further acknowledge that Tribal Voice can not guarantee that I will not become infected with the Coronavirus/Covid-19. - I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, shop/piercing staff, and other customers and their families. - I voluntarily seek services provided by Tribal Voice and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19. - I acknowledge that I must comply with all set procedures to reduce the spread while attending my appointment. I attest that: - I am not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell. - I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19. - I have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non contagious by state or local public health authorities. - I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19. I hereby release and agree to hold Tribal Voice harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of the studio/store, or that may otherwise arise in any way in connection with any services received from Tribal Voice. I understand that this release discharges Tribal Voice from any liability or claim that I, my heirs, or any personal representatives may have against the studio/store with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from Tribal Voice. This liability waiver and release extends to the studio/store together with all owners, partners, and employees. I have read and understood the terms and will follow all procedures, as stated by the Covid-19 Liability Waiver * What's Next? - Please book an appointment with us online. Note: Before attending your appointment, you must have eaten a full meal within the last 4 hours, not taken any blood thinning medication (non-prescribed), recreational drugs or alcohol* - Jewellery will be shown on the day & piercing prices will also be confirmed on the day, as this may vary depending on the jewellery chosen. lease bare in mind the prices online are the MINIMUM you will pay. - Please notify us of any changes in circumstances or if you're running late, as soon as possible. - Any late/missed appointments without notifying us beforehand, will be removed and you will have to re-book. Please be aware, if you are running late and we are fully booked we will not be able to move your appointment. - Photo ID is required during your appointment, please make sure to bring this with you. If you arrive with a birth certificate and nothing else you will not be pierced and your deposit will not be refunded. - If Parental Consent is required, the parent/guardian must be present in-store during the appointment. - Parent/Guardian's must have their own Photo ID and a copy of the applicant's Birth Certificate (or other proof of guardianship) during the appointment* *We have the right to refuse anyone, under our own discretion, no matter the reason. Covid-19 Requirements* We ask you to please reschedule your appointment if you: - Are currently feeling unwell. - Have been unwell within the past 2 weeks - Have been in contact with anyone feeling unwell You can reschedule your own appointment through your confirmation email. If it is under 24 hours, unfortunately you will need to rebook and your current deposit will be lost. *We have the right to refuse anyone, under our own discretion, no matter the reason. Have you booked your appointment? * Yes No Only 1 appointment is needed for this application. Appointment Date Selected * Deposit Order Number (#) * This will be sent to you in an email once we receive your order. Appointment Time Selected *