Ear Piercing Declaration

If you are under 16 years of age then you will need to attend with a parent, or guardian, who will sign a declaration form on your behalf.

Otherwise, you will be asked to sign a printed version of this declaration form and a copy of this will be given to you. If you have any health issues, it is a good idea to read this through now, to see if there are any reasons why you may not be able to have your ear pierced. Sometimes it is OK, but advice from a Doctor may be needed before going ahead.


Please accept my authorisation to pierce my ears. I have read and understand the following information, which is of considerable importance in taking precautions to avoid any possible problems arising from my treatment. By my signature on the CAFLON RELEASE FORM AUTHORISATION AND EAR PIERCING APPLICATION, I truthfully declare the following:

  • I am not under care of my doctor for any condition which should prohibit me from having my ears pierced. Should I be under the care of a doctor, e.g. pregnant, I have my doctor’s permission to have my ears pierced.
  • I am not suffering from Diabetes, Epilepsy, Hepatitis, HIV, Haemophilia or Dizziness and I am not taking any blood thinning medication.
  • I am not under the influence of drugs or alcohol.
  • I have been give a copy of the CAFLON After care Procedure on the reverse side of this declaration form, which I have read and understand.
  • I understand that the possibility of infection may exist due to improper hygiene, metal sensitivity or other causes, however the most common is due to a failure to follow carefully the recommended After Care Procedure.
  • I understand the due to the nature of ear piercing; exposure to the newly pierced ear to certain environments such as swimming and participation in athletic events (exercising) may increase the likelihood of infection.
  • I therefore undertake to follow carefully the After Care Procedure.
  • I am not under 16 years of age, or having given consent on behalf of a minor under 16 years of age, that I am parent or legal guardian of such minor. If signed as a parent or legal guardian on behalf of a minor, I will hold myself liable and will indemnify the premises in the event such as a minor makes a claim as a result of the ear piercing procedure.



By signing the CAFLON RELEASE FORM, AUTHORISATION AND EAR PIERCING APPLICATION I declare I have read and understand the following information:

  • Wash hands thoroughly before touching studs or ear.
  • Cleanse front and back of the ear 2 times a day with CAFLON Natural Solution without removing studs. Then rotate studs 2 or 3 times, 180 degrees left and 180 degrees right, i.e. a half turn, thus avoiding hair wrapping around the post at the back of the lobe. In between cleansing, the ear should be kept DRY.
  • Keep hair spray, soap, shampoo and other preparations away from the ear. After shampooing, the ear should be rinsed with clear water and then cleansed with CAFLON Natural Solution as described above.
  • The piercing area should be CLEANSED with CAFLON Natural Solution then kept DRY, especially after bathing, swimming or exercise.


  • Remove studs or handle your ears and/or studs unnecessarily
  • Push the butterfly along the post towards the ear – the butterfly must always be positioned at the tip of the post. Feel the position each time you clean the ear – it must feel smooth. This ensures that the earring remains LOOSE during the healing period. This is essential as tight may lead to inflammation.


  • Leave studs in the ears for 6 weeks continuously.
  • After 6 weeks, the stud can be removed and other post-type earrings may be worn continuously.
  • Use only post-style earrings continuously for the first 6 months from piercing. The post should be surgical stainless steel or other hypo-allergenic material.

Minor pain/redness may occur immediately – this is normal. This will settle within 48 hours provided proper after-care is carried out. If undue pain/swelling/redness occurs at any time, seek medical advice before removing the ear-piercing stud.