consent form

First and last name: ................................ .

Street: ............................................ .

Piz, place: .......................................... .

Hereinafter referred to as customer, the following is agreed:

The customer receives the following piercing

1.) The piercing treatment to be carried out by us is carried out according to the
"State Ordinance on the Prevention of Blood Contact Infections" are made,
This means that only single-use instruments are used.

2.) The customer hereby agrees to the treatment related to the piercing
physical intervention expressly and declares that he illnesses or
Diseases that exclude piercing treatment or entail risks,
are not known.

3.) It is the sole responsibility of the customer to in case of doubt before the
Piercing treatment with a competent doctor about the risks of such
to discuss treatment.

4.) It is hereby expressly pointed out that even with healthy customers
and when used properly, inflammation can occur. The customer
wants the piercing regardless and releases the piercer from any liability
from the point of view of damages and compensation for pain and suffering.

5.) The piercer is only liable for intent and gross negligence.

6.) In particular, the piercer assumes no liability for any attachment of
Body jewelry and indicates that in the event of the occurrence of

inflammation, consult a doctor immediately. A liability of the piercer for
improper further treatment in the event of inflammation is excluded.
7.) The customer hereby confirms that they have received the "Care Instructions" piercing leaflet
and to have been made aware of the information contained therein.

Worms, the ~ .

Signature : ....................................... .