In consideration of receiving a piercing at Pushing Inc. Tattoo Emporium (together with its employees, apprentices and agents, the “Tattoo Studio”), I agree to the following:

*

I acknowledge the inherent risks associated with getting a piercing, including potential infection, scarring, and allergic reactions. I accept all risks involved and waive all claims against the Artist and Tattoo Studio for any injuries resulting from the tattoo process.

*

I confirm that I have no medical conditions that may interfere with the process and am not under the influence of substances. I understand that tattoos are permanent and can be costly to remove.

*

I release my rights to any photographs taken of me and my piercing unless I specify otherwise.

Please fill out the following:

Client Full Name *

Guest Piercer Name

Date: *

Phone *

Email *

Date of birth *

Address *

Age: *

Please check the following if they apply to you: *

Alcohol consumption in the past 24 hours

Use of pain relievers

Prone to fainting

Consumed food in the past 2 hours

Would you like to receive our newsletter? *

Yes

No

Piercing Type *

Jewelry Size

Jewelry Material

Client Signature *

Clear

For Minors:

Parent Acknowledgement

I, the parent/guardian of the minor participant, agree to release all claims and confirm I will accompany the minor to the appointment with valid ID.

Parents Signature

Clear