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👶 Infant & Child Ear Piercing Consent Form

Relationship To Child

I confirm that:

  • I am the parent or legal guardian of the child named above
  • I have full authority to give consent
  • All information provided is true and accurate

I give permission for ear piercing to be carried out at The Viper Pit Tattoo Studio.

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Child Medical Infomation
Was the Child Born Premature

Procedure Understanding

I understand that:

  • The procedure involves piercing the ear using sterile, single-use equipment
  • The child may experience brief pain, redness, or swelling
  • There is a small risk of infection, irritation, or allergic reaction
  • Jewellery used is suitable for initial piercing

Placement Acknowledgement (IMPORTANT)

I understand that:

  • Piercing placement is agreed before the procedure
  • While every effort is made to ensure symmetry, perfect symmetry cannot be guaranteed
  • As the child grows, ear shape and position may change, which may affect the long-term appearance of the piercing

Aftercare Agreement

I confirm that:

  • I have received and understand aftercare instructions
  • I will follow all aftercare advice provided
  • I understand improper aftercare can lead to complications

Liability & Responsibility

I acknowledge that:

  • All reasonable care and hygiene standards have been followed
  • The studio and practitioner cannot be held responsible for:
    • Infection due to improper aftercare
    • Undisclosed medical conditions
    • Normal healing complications

Behaviour & Safety

I understand that:

  • The procedure will only go ahead if it is safe to do so
  • If the child is excessively distressed or uncooperative, the procedure may be stopped
Confirmation
e.g 03-01-2025
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