Piercing Consent & Release Form | Multnomah Body Piercing

1 ID Verification

Oregon law requires valid government-issued photo ID for all piercing clients and parents/guardians of minors

Accepted: Driver's License, State ID, Passport, Military ID

Tap to scan your photo ID

We'll use your device camera to photograph your ID

Photo ID scan is required

2 Client Information

All fields marked with * are required — name must match your ID

Full Legal Name (as on ID) *

Full legal name is required

Date of Birth *

Date of birth is required

Phone *

Phone number is required

Email Address *

Email address is required

Street Address *

Street address is required

City *

City is required

State *

ZIP *

ZIP is required

3 Minor Consent

Parent/Guardian Full Legal Name *

Parent/guardian name is required

Relationship to Minor *

Relationship is required

Guardian Phone *

Guardian phone is required

Guardian Email

Guardian Photo ID *

Tap to scan guardian's photo ID

Parent/guardian must present valid government-issued photo ID

Guardian ID scan is required

Parent/Guardian Signature *

Parent/guardian sign here

Guardian signature is required

Minor's Signature *

Minor sign here

Minor's signature is required

I, the undersigned parent/legal guardian, hereby consent to the body piercing of the above-named minor. I verify that I am the legal parent or guardian and am presenting valid photo identification. I understand that under Oregon law (ORS 690.350), body piercing of a minor requires written consent of a parent or legal guardian who must be present during the procedure.

4 Piercing Selection

Choose your piercing, placement, and jewelry

Piercing Type *

Please select a piercing type

This piercing is not available for your age group under Oregon law

Piercing Location *

Please select a location

Jewelry Material *

Please select a jewelry material

Jewelry Type *

Please select a jewelry type

7 Consent & Release

Please read and acknowledge each statement — all checkboxes are required

I confirm I am at least 18 years old OR my parent/legal guardian is present and has signed this form. I have not consumed alcohol or recreational drugs within the past 24 hours. I have truthfully disclosed all medical conditions, allergies, and medications. I understand that body piercing involves risks including but not limited to: infection, allergic reaction, scarring, keloid formation, nerve damage, migration, rejection, and prolonged healing. I understand that proper aftercare is my sole responsibility and I have received aftercare instructions. I understand the piercing may not heal properly and may need to be removed at my own expense. I voluntarily consent to this body piercing procedure and release Multnomah Body Piercing, its owners, employees, and agents from all liability for complications arising from this procedure or failure to follow aftercare instructions. I authorize Multnomah Body Piercing to photograph my piercing for portfolio/marketing purposes. (OPTIONAL) I agree to the Privacy Policy and understand how my data will be stored and used.

8 Stay Connected (Optional)

Deals, Reminders & Gold Card

I'd like to receive text message deals and reminders from Multnomah Body Piercing. Msg&data rates may apply. Reply STOP to opt out at any time. I'd like to receive email newsletters and promotions. I'd like to join the Gold Card loyalty program (auto-enroll, earn rewards on every visit).

By opting in to SMS, you consent to receive automated text messages from Multnomah Body Piercing at the phone number provided. This is not a condition of purchase. Message frequency varies. Reply HELP for help, STOP to cancel.
SMS Terms • Privacy Policy

10 Review & Submit

By submitting this form, you agree that all information provided is accurate and complete. This digital consent form complies with Oregon Administrative Rules Chapter 331, Division 900 governing body piercing. A copy will be retained per Oregon record-keeping requirements. Form data is stored securely and encrypted at rest.

PARENTAL / GUARDIAN CONSENT REQUIRED

Your complimentary downsize is included!

Deals, Reminders & Gold Card

Consent Form Submitted