Before your visit

Piercing Release Form

Please complete this release form before your piercing appointment. Under 18? Florida law requires a notarized parent or guardian consent, handled in studio – just bring your ID and your parent. Questions? Reach out any time.

Name(Required)
MM slash DD slash YYYY
Address(Required)
For example: left helix, septum, navel.
Accepted file types: jpg, jpeg, png, gif, webp, heic, pdf, Max. file size: 64 MB.
Do any of the following apply to you? (check all that apply)(Required)
This stays private and simply helps your piercer keep you safe.
I certify that I am 18 years of age or older, that the government-issued photo ID I have provided is mine and is valid, and that all information I have given is accurate. I understand that Florida law (s. 381.0075, F.S.) requires anyone under 18 to have the written, notarized consent of a parent or legal guardian on file with the studio before being pierced, and requires anyone under 16 to be accompanied by that parent or legal guardian. Minors cannot complete this online form; consent for a minor is handled in studio.(Required)
I understand that body piercing carries inherent risks including, but not limited to: infection, allergic reaction to jewelry or products used, prolonged bleeding, swelling, scarring or keloid formation, migration or rejection of the piercing, nerve damage, and extended or incomplete healing. I understand that healing times vary by placement and by person, and that no specific result can be guaranteed.(Required)
I certify that the health information I have provided on this form is true and complete, that I am not under the influence of drugs or alcohol, and that I will inform my piercer of any medical condition, medication, or allergy that could affect my piercing or its healing.(Required)
I acknowledge that I have received written aftercare instructions from Pokes and Pouts, that they have been explained to me, and that I agree to follow them. I understand that how well my piercing heals depends substantially on my own care of it after I leave the studio.(Required)
In consideration of receiving a body piercing from Pokes and Pouts, I hereby waive and release, to the fullest extent permitted by law, Pokes and Pouts, its owner, and its employees from any and all claims, damages, or causes of action arising from this procedure or its aftermath, except where caused by gross negligence or willful misconduct. I accept full responsibility for my decision to be pierced.(Required)
The parties will attempt to resolve any dispute arising out of or relating to this agreement through friendly negotiations. If the matter is not resolved by negotiation, the parties will resolve the dispute using the below Alternative Dispute Resolution (ADR) procedure: mediation, and if mediation is unsuccessful, binding arbitration in Orange County, Florida.(Required)
Optional: I authorize Pokes and Pouts to photograph my completed piercing and to use those images for its portfolio and social media. Declining does not affect my appointment in any way.
I HAVE READ THIS DOCUMENT AND UNDERSTAND ITS CONTENTS. I UNDERSTAND THAT BY SIGNING IT I AM GIVING UP CERTAIN LEGAL RIGHTS, AND I SIGN IT FREELY AND VOLUNTARILY.(Required)