I First Name* hereby declare that I give Please Select Manu Ana Moe Bruno Diogo * full consent to pierce my Please Select Anti-tragus Ear lobe Eyebrow Daith Helix Forward Helix Labret Nostril Navel Tragus Rook Scafold Septum Smiley Snug Tongue Genital Microdermal Nipple Bridge Conch * and that all the information given is true to my knowledge.