Under 18 - Consent Form

Under 18 - Consent Form
Date

MonthDayYear
Date
Name of Parent or Legal Guardian:

First NameLast Name
I hereby swear or affirm under penalty of perjury, that the following facts as stated in this document are true:
I am the natural parent or legal guardian of:
The Minor Child's date of birth is:
The child's age is:
I have the legal authority to give consent to the body piercing of this child: (initial below)
I consent to the body piercing of my child's: (location of piercing on child)
Signature of Parent/Legal Guardian
Should be Empty: