This is to certify that I, the undersigned person, today gave my correct name, date of birth and address when asked to do so by Bournemouth Tattoo Ltd " ta Jynx Tattoo & Piercing" located at 3 Lansdowne Crescent, Bournemouth, BH1 1RX.

I confirm that I understand that I must be 16 years or older " or have parental/guardian consent " to obtain a piercing. This is to certify that the above named and undersigned do give consent to be pierced at there own free will, are fully aware of the process imvolved and understand the importance of daily aftercare. You agree to follow the aftercare instructions given to you on the piercing aftercare sheet. If the signed suffers or has suffered from any of the above, they should consent there doctor before proceeding. I confirm that I am not under the influence or drugs or alcohol. I understand that piercings can sometimes reject/ migrate, that scaring can occur and oral piercings can cause dental damage. We strive to minimise the ricks of complications but inevitablely problems may occur with some people.