DOWNLOADED SKIN PIERCING
CONSENT FORM

To be filled in clearly and correctly by persons wishing to be pierced

          NAME…………………………………………...
          ADDRESS……………………………………….
          ……………………………………………………
          TELEPHONE…………………………………...
          AGE………………………………………………
         D.O.B…………………………………………….

This is to certify that I, the above named and undersigned, today gave my correct name, address and age when asked to do so by Niall Edwards or to a member of his staff.  I have been informed of the risks associated with body piercing and answered relevant medical questions.

SOMETHING DIFFERENT, 13 GT GEORGE ST, WEYMOUTH, DORSET

This is to certify that I, the above named and undersigned, do give my permission to be pierced by Niall Edwards and I am fully aware of the procedures involved and understand the importance of daily aftercare procedure.

SIGNED………………………………………………….
DATE…………………………………………………….

Where the client is under 16 the parent or guardian must also complete their details and sign the declaration. Parents will be contacted prior to the piercing taking place to confirm that a parent did complete it. Any doubt will result in the piercing not being performed.

SIGNED………………………………………………….
         PRINTED………………………………………………..
DATE…………………………………………………….
TYPE OF PIERCING ALLOWED……………………
CONTACT TEL No…………………………………….