Piercing Release Form

Important Instructions for Completing Your Consent Form

  1. When to fill this out: If you prefer, you will have the opportunity to fill out your form during your scheduled appointment time. Consent forms must be completed within 24 hours before your appointment. If completed earlier, you will need to fill out a new form when you arrive to ensure all information is current.
  2. Save Your Progress:
    • IMPORTANT: To save your form and complete it later, enter our email address: avaconsent@gmail.com in the designated field. This step is essential for saving your progress.
  3. Signature & ID:
    • IMPORTANT: You will still need to sign the form in person and show a photo ID during your appointment. The online form does not save signatures or photos.
  4. Submitting: At the end of the form, select Save and Resume, you will then be prompted to input our email address.
  5. Need Help?: If you have questions, feel free to contact us at avapiercing@gmail.com

Let us handle this part!

If you're filling this out before your appointment, skip this section please!
Unspecified: rook, navel, industrial, eyebrow, or undecided piercing
Click or drag files to this area to upload. You can upload up to 4 files.

WAIVER, RELEASE, AND CONSENT TO BODY PIERCING

PLEASE READ AND BE CERTAIN THAT YOU UNDERSTAND AND AGREE TO THE IMPLICATIONS OF SIGNING THIS DOCUMENT.
PLEASE READ CAREFULLY AND THEN INITIAL NEXT TO EACH PROVISION TO SHOW THAT YOU UNDERSTAND AND AGREE TO WHAT IS WRITTEN.

Please initial in all of the spaces provided

By initialling you show that you have read and understand all of the provisions below

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Please initial above. If you prefer not to have photos of your piercings taken, please leave this blank.
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PLEASE READ CAREFULLY BELOW AND ANSWER YES OR NO TO THE FOLLOWING QUESTIONNAIRE AND PROVIDE DETAILS WHEN NECESSARY.

We cannot pierce anyone who is pregnant or nursing.
We do not use latex gloves for any procedure.
We're happy to make whatever accommodations we can! Please let one of our staff know if we need to pay extra close attention to this section. If you need us to keep this discrete, please input that into the notes and we'll make sure to use extra caution.

If there is any provision, section, subsection, clause, or phrase of this release that is found to be unenforceable or invalid, that portion shall be severed from this contract. The remainder of this contract will then be reconstructed as though the unenforceable portion had never been contained in this document.

I hereby declare that I am of legal age, have provided valid proof of my age, and am competent to sign this agreement or, if not, that my parent or legal guardian shall sign on my behalf, and that my parent or legal guardian is in complete understanding and concurrence with this agreement.

I HAVE READ THIS AGREEMENT, I UNDERSTAND IT, AND I AGREE TO BE BOUND BY IT.

Clear Signature
If you are under the age of 18, you will sign here and your parent/guardian will sign below. If you are over the age of 18, sign here. You will not need to sign in the second signature box.
Save and Resume Late