Laughing Buddha Insert, Removal, and Stretching Consent Form (Minor)

Thank you for choosing Laughing Buddha for your procedure 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

We understand, acknowledge and agree that we have hired Laughing Buddha and/or their employee’s to stretch and or Insert jewelry into the minor’s piercing. These services may use tools which include but are not limited to; Insertion tapers and/or any ring expanding pliers, benders, closers, or addition tools needed to complete the procedure.

Insertions and/or Stretches can cause the piercing to become sore, irritated, tender, inflamed and can at times cause a fully healed piercing to become irritated.

Complications with such procedures could include symptoms such as but not limited to: swelling, bleeding, bruising, tenderness, irritability etc.

We have been informed of the inherent risks associated with the procedure that we are requesting to have performed, and have been given the chance to ask any questions regarding said procedure.

The Undersigned and Minor hereby voluntarily assumes any and all risk of injury, harm and/or damage resulting from or in connection with the above services.

The Undersigned and Minor further agree to indemnify and do indemnify the Releasees from any and all claims, demands, actions, liability and/or damages whatsoever whether arising from negligence or in any other manner made by any individual or entity against Laughing Buddha. related to my acts and/or omissions. The indemnification shall include, but shall not be limited all attorney’s fees and costs incurred.

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.

I have read and understand this entire document. I understand that it contains release of all claims, waiver of liability, my assumption of all risk, and an agreement for indemnification.

I declare under penalty of perjury under the laws of the state of California that the foregoing is true and correct and that I voluntarily sign my name evidencing my acceptance of all the above provisions.

Menu