Piercing (Adult) Release Form

Basic Info:

Today's Date:

Mon Jun 22 2026 09:11:26

Artist:*

Piercing Location on Body:*

How did you hear about us?:*

Please read & answer:

Booking & Pricing*

I understand and agree to the booking & pricing information listed below.

Booking Fee: If you paid a fee when booking your appointment, it will applied towards your final bill.

Jewelry is purchased separately and ranges from $30 to $500 depending on which piercing it is for and the type of metal.

Pricing: I have been given my final price (barring any changes) by my piercer and agree to pay the final amount calculated at end of the procedure.

Release*

By signing this Release, I have been given the full opportunity to ask all questions that I might have about obtaining a piercing, and all my questions have been answered to my complete and total satisfaction. I acknowledge I have been advised of the matters set forth below, and I agree as follows:

Health History*

I am not pregnant or nursing. If I have any condition that might affect the healing of this piercing, I will inform my Piercer.

I do not suffer from medical or skin conditions such as but are not limited to, keloid or hypertrophic scarring, psoriasis at the piercing site, or any open wounds or lesions at the site of the piercing.

I have advised the Piercer of any allergies to metals, latex gloves, soaps, and medications.

I acknowledge that the Piercer cannot determine whether I might have an allergic reaction to the piercing or processes involved in the piercing and further recognize that such a reaction is possible.

I affirm that I do not have diabetes, epilepsy, hemophilia, or a heart condition or take blood thinning medication.

I do not have any other medical or skin condition that may interfere with the procedure or healing of the piercing.

I am not the recipient of an organ or bone marrow transplant; if I am, I have taken the prescribed preventive regimen of antibiotics that my doctor requires before any invasive procedure, such as piercing.

Informed Consent*

I have trustfully represented to the Piercer that I am over the age of 18 years. I am not under the influence of drugs or alcohol. To my knowledge, I do not have any physical, mental, or medical impairment or disability which might affect my well-being as a direct or indirect result of my decision to have a piercing done at this time.

Both the Artist and the Piercing Studio have given me the full opportunity to ask all questions about the piercing procedure, and they have been answered to my total satisfaction I affirm that I am not under the influence of alcohol or drugs and voluntarily getting a piercing without duress.

I acknowledge that I have been given adequate opportunity to read and understand this document, that it was not presented to me at the last minute, and that I am signing a legal contract.

Permanence*

I acknowledge that obtaining this piercing is my choice alone and will result in a permanent change to my appearance and that no representation has been made to me as to the ability to restore later the skin involved in this piercing to its pre-piercing condition.

I acknowledge that the piercing will permanently change my appearance and that my skin may not be restored to its pre-piercing condition even after its removal, as scars and indents may be left on the skin.

Risks*

I have been informed of the risks of getting a piercing. I understand that known and unknown risks can lead to injury, including but not limited to infection, scarring and keloid, and allergic reactions. Having been informed of the potential risks associated with getting a piercing, I still wish to proceed with the piercing, and I freely accept all risks that may arise from piercing.

Aftercare*

I affirm that I have given instructions on caring for my piercing while it's healing, and I understand them and will follow them. I acknowledge that it is possible that the piercing can become infected, particularly if I do not follow the instructions. I have received aftercare instructions and agree to follow them all while my piercing is healing.

Sterilization*

I understand I will be pierced using appropriate instruments and sterilization.

Indemnification*

I agree to indemnify and defend Ro Bataille, LLC, Iron Cherry, LLC, Cherry Bomb Studio, my service provider, as
well as any representatives, employees, contractors, and agents against all claims, causes of action, damages,
judgments, costs, or expenses, including attorney fees and other litigation costs, which me in any way arise for my use
of or presence upon the facilities of Cherry Bomb Studio located at 231 Eldridge Street.
I agree to release and forever discharge and hold the Piercer and all employees harmless from all claims, damages, or
legal actions arising from or connected with my piercing or the procedure and conduct used in my piercing.
I agree to waive and release to the fullest extent permitted by law each of the Artist and the Studio from all liability
whatsoever for any claims or causes of action that I, my estate, heirs, executors, or assigns may have for personal
injury or otherwise, including any direct and consequential damages, which result or arise from my piercing, whether
caused by the negligence or fault of either the Artist or the Piercing Studio, or otherwise.
I agree to reimburse each of the Artist and the Piercing Studio for any attorneys' fees and costs incurred in any legal
action I bring against either the Artist or the Piercing Studio and in which either the Artist or the Piercing Studio is the
prevailing party. I agree that the courts of New York shall have personal jurisdiction and venue over me and shall have
exclusive jurisdiction for litigating any dispute arising out of or related to this agreement.

Unenforceability*

I understand Release of Liability or unenforceability of any provision of this Release of Liability shall not affect any
other condition in this Release of Liability or other applications of such provision, and such unenforceable provision
shall be deemed not to be part of this Release of Liability.

Mediation*

I agree that the parties will attempt to resolve any dispute arising from or relating to this Release of Liability through
friendly negotiations. If the matter is not resolved, the parties agree to use mediation.

Payments*

I have read and agree with the pricing and policies.
Payment will be made to the Business via cash or any other payment method determined
by the Business.

I understand that my final price may differ from what is reflected in this appointment booking due to either error while
booking or additional, less, or other services provided.
After completing my service, I agree to pay the remainder of the total final price calculated and requested. If I have
questions about pricing, I will ask for that information before my appointment begins.
Unless previous arrangements are made, if I refuse to pay the requested amount at the time of service, my card on file
may be charged that amount, and Ro Bataille, LLC will provide me with an itemized receipt of the charges.

Authority*

Each party has the authority to enter this Contract and perform all its obligations under it.

Signatures*

This Contract may be signed electronically or in hard copy. Electronic signatures count as original for all purposes.

Changes*

The Client and the Business must agree to any changes to this Contract in writing.

Acknowledgement*

I have read this document and understand its contents. I acknowledge that the information I gave in this form is accurate and complete. I know that I voluntarily surrender certain rights by signing this Release of Liability. By
signing below, I confirm that I understand and agree to all terms and statements in this form.
I certify that I am a competent adult of at least 18 years of age. This consent form is freely and voluntarily executed
and shall be binding upon my spouse, relatives, legal representatives, heirs, administrators, successors, and assigns.
I have read and understand this agreement. The nature and purpose of the treatment have been explained to me. All my
questions have been answered to my satisfaction, and I consent to the terms of this agreement.
By signing your name as a signature below, you agree to the terms and provisions of this agreement.

Photo Release*

I release all rights to any photographs taken of me and the piercing and consent to their reproduction in print or
electronic form. My pictures may appear in print or online or new media. I permit to use of my photos for marketing. (If you choose
NO this provision, please advise your Artist).

If any provision, section, subsection, clause or phrase of this release is found to be unenforceable or invalid, that portion shall be severed from this contract. The remainder of this contract will then be construed as though the unenforceable portion had never been contained in this document.

Personal Info

I hereby declare that I am of legal age (with valid proof of age) and am competent to sign this Agreement.

Name:*

Address:*

Date of birth:*

Phone #:*

Email:*

Signature:*

Photo ID(s)*

Please take a picture of your government issued photo ID