I acknowledge that I have fully and truthfully represented to the associates, agents, and representatives of MOONLIGHT GALLERY that I am over 18 years of age and/or have legal consent by my legal guardian if under the age of 18 years of age.

I acknowledge that I am free of any communicable disease and if not, I have advised my piercer of any existing communicable disease I may have (e.g., HIV/AIDS, Hepatitis, etc. I do not have any medical skin conditions, such as (but not limited to): acne, scarring/keloid, eczema, psoriasis, vitiligo, rash, infections, lesions, freckles, moles or sunburns in the area to be pierced that might agitate the piercing process/healing.

I am neither pregnant nor nursing.

I understand that undergoing any skin treatments, laser therapy, plastic therapy, plastic surgery, or other skin altering procedures may result in adverse changes to my piercing.

I acknowledge I may not have the correct anatomy for the desired piercing and I am aware the piercer has the right to refuse service.

To my knowledge, I do not have any physical, mental, or medical impairment that may affect my well-being as a direct or indirect result of my decision to have a piercing.

I acknowledge that there is a chance that I might feel lightheaded, dizzy or in the worst-case scenario, faint, during or after the piercing procedure. I agree to immediately notify the practitioner in the event of any of these happening and have been advised to seek medical care if worsening conditions.

I have agreed to the location/ placement I would like to get pierced.

I understand that by getting a piercing, complications might occur such as infections, aesthetic imperfections as a result of individual skin healing, discoloration, migration, crusting, and/or in seeping, among others.

I have received written instructions advising how to properly care for my piercing and recognize the absolute necessity and importance of following those instructions. All questions about the body art procedure have been answered to my full comprehension and satisfaction.

I acknowledge that obtaining this piercing is my choice alone and will result in a permanent change to my appearance, and no representations have been made to me as to the ability to later restore the skin involved to it's pre-pierced state.

I agree to follow all shop and artist instructions and rules that are provided to me.

I give full consent of any videos and/or pictures taken of me and of my art to be uploaded to social media (i.e., Instagram, Tik Tok, Facebook, Twitter, etc.)

I agree to release and forever discharge and hold harmless MOONLIGHT GALLERY and its associates, agents, officers, and shareholders from all claims, damages, or legal actions arising from or connected in a way with my piercing or the procedures/products used on my piercing and all piercings applied by ___________ and his/her associates, agents & representatives in the future.

I acknowledge that by signing this consent form I have been given the full opportunity to ask any questions I might have about obtaining a piercing . I acknowledge that all my questions have been answered to my full and total comprehension. I specifically acknowledge that I have been advised of the facts and matters

I am aware that I am responsible for any jewelry replacements if my jewelry falls out after 48 hrs from receiving the piercing.

By checking this box, I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing. I further acknowledge that MOONLIGHT GALLERY has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19. I further acknowledge that MOONLIGHT GALLERY cannot guarantee that I will not become infected with the Coronavirus/COVID-19. I am acknowledging that there is an inherent risk of exposure in any public place where people are present. Also, I (and any guests), voluntarily assume all risks and responsibilities related to exposure to COVID-19 and agree that MOONLIGHT GALLERY, the artist, or any of their affiliate employees are not liable for any illness during or after my tattoo.

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