1. Name piercing artist: Bella

Address Studio
Swallow Ink Tattoo
Steenbergsestraat 44
4611 TG, Bergen op Zoom

Customer information:

Date of birth:

E-mail address customer:

2. Customer statement:
I have considered the following information about the risks of getting a piercing:

I have been informed about the possible risks and complications that can occur when getting a piercing and I understand the information fully.
I am not currently under the influence of alcohol or drugs or any other substance that may affect my perception, free will and judgment.
The aftercare procedure has been clearly explained to me and I understand what I have to do and which precautions I have to take. I will take my own copy of the aftercare procedure home with me.
I agree that the piercing will be placed as described under point 3 by the named piercing artist.
I confirm that the piercing artist may keep this consent form on file in accordance with the AVG law.
I am aware of and accept the risks and potential complications associated with getting pierced.
I confirm that I have given the above information and statements in good faith and that they are correct.

Piercing artist statement:
I confirm that the piercing process is performed under hygienic conditions with suitable sterile instruments, safe techniques and according to NEN 17169 and REACH and corresponding national requirements.
I confirm that a copy of this signed consent form has been provided to the client and that the client has been advised to retain the information.

Signature date:

Handtekening Piercer:

Signature costumer: