Laughing Buddha Piercing Release Form (Minor)

Thank you for choosing Laughing Buddha for your piercing today. Please have your ID handy and complete the following form. For security, the contents of your submission will be emailed to our staff and not stored on our web server.

If you are not a minor use this form.






Consent

I, the undersigned Parent/Guardian of the undersigned minor hereby consent to the specified piercing, to be conducted by Laughing Buddha, or any agent or employee of the same as follows:

I acknowledge by signing this release that I have been given full opportunity to ask any and all questions that I may have and that all my questions have been answered to my full and total satisfaction. To endure the efficiency of healing, I will inform Laughing Buddha of any conditions, medical or otherwise, which may impair the full and proper healing of my piercing.







Medical Questionnaire

The following medical questions are confidential, and solely used by the staff at Laughing Buddha Body Piercing to ensure the procedure is being performed safely.

YESNO
YESNO
YESNO
YESNO
YESNO
YESNO
YESNO
YESNO
YESNO
YESNO
YESNO
YESNO

Identification

PARENT/GUARDIAN: Please provide a copy of your ID. You can take a picture with your phone and attach the image here.

MINOR: Please provide a copy of your ID.

Please provide a copy of MINOR's Birth Certificate.

The undersigned for himself or herself, the heirs, successors, representatives as assigns hereby forever waives releases and discharges Laughing Buddha Body Piercing, their agents, employees, representatives, and other organizations affiliated with this studio and any and all of their heirs, successors or assigns (hereinafter referred to as Releasees.)

The undersigned further agrees to indemnify and do indemnify the Releasees from any and all claims demands, actions, liability and/or damages whatsoever performed under this agreement. The indemnification shall include, but shall not be limited to any and all attorney fees and costs incurred.

Menu