Johnny Two Thumb Perth — Piercing Consent Form

01 · Client information

Full name *

Date of birth * (ID required)

Phone number *

Email address *

Emergency contact name & phone *

02 · Medical history

Do you have or have you ever had any of the following? Check all that apply.

Diabetes Epilepsy or seizures Hemophilia or other bleeding disorders Heart conditions Skin conditions (e.g., eczema, psoriasis) Allergies (including to latex, metals, iodine, antiseptics) Hepatitis A/B/C or HIV/AIDS Keloid or excessive scarring Are you pregnant or nursing?

If you checked any of the above, please describe (optional)

05 · Consent & release

I, hereby consent to receive the body piercing procedure described above. I understand and agree to the following:

I confirm that I am at least 18 years of age (or have parental/legal guardian consent if underage — see below).
I understand that all piercing procedures carry risks including, but not limited to: infection, allergic reactions, scarring, and prolonged healing time.
I confirm that all information provided on this form is accurate to the best of my knowledge.
I have been informed of and understand the proper aftercare instructions and agree to follow them.
I understand that if I do not follow the aftercare instructions, I risk complications that are not the responsibility of the studio or the piercer.
I release the piercer and studio from any liability that may result from this procedure.

I have read this Piercing Consent & Release Form and I agree to be legally bound by it.

Client signature

06 · For minors (if under 18)

Parent/legal guardian name *

Relationship to minor *

Phone *

I confirm that I am the parent or legal guardian of the minor named above and give my full consent for the body piercing procedure described. I have read and agree to the terms outlined above.

Parent/guardian signature

Photo ID — minor *

Photo ID — parent/guardian *

✓

Consent recorded

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