Piercing Release Form

I certify that:

(1) I am 18 years of age or older and have provided state or federal government issued photo identification proving so.

(2) I/We understand and acknowledge the significance and consequence of the procedure and hereby assume full responsibility.

(3) I understand that piercing may require surgical removal which could lead to scarring or disfigurement.

(4) I understand and agree to follow the instructed aftercare to ensure proper healing of my piercing and understand that not following suggested procedures may lead to infection or damage to the piercing or surrounding skin and it is my sole responsibility to consult a piercer with any questions or concerns as needed.

(5) I understand that the proposed healing time is 10-15 days and is only an estimate and that the actual piercing healing time may vary. (6) I understand that an allergic reaction is possible with any piercing, and it is impossible for a piercer to know ahead of time that I could have such a reaction.

Therefore, I am releasing the artist and Mad Monk Tattoo from any liability if such an event occurred.

Please check any of the following that apply to your current health status if you have experienced them within the last 12 months:

I certify that under the penalty of perjury that all the information provided above is correct and true to the best of my knowledge. My signature below gives Mad Monk Tattoo permission to use any photographs of me or my tattoo for promotional use with no demand for compensation or name recognition. I understand that my tattoo was done by an independent contractor renting a space from Mad Monk Tattoo and expressly release Mad Monk Tattoo from any and all liability, claims, demands, damage, injury, or grievances. I agree that any claims, demands, damage, injury, or grievances shall be the sole responsibility of the independent contracted individual who performed the service. Contractor waives and releases and shall indemnify, protect, defend, and hold harmless Mad Monk tattoo and its owners, agents, contractors, and employees against any and all loss, claims, damages, or liability arising out of or in connection with loss of life, personal injury, property damage, or otherwise arising from the use, occupation, or managing the space on premises or from any act of omission of contractors of its assignees or sub-licenses or their respective agents, employees, or licenses.

**3% SURCHARGE FOR ANY DEBIT OR CREDIT CARD USED**