(PARENT) MINOR BODY PIERCING CONSENT FORM

GOOD PAIN ARTWORKS • 112 NE 4th St., Grand Prairie, TX, 75050 • (214) 518-6235
CLIENT INFORMATION

All information provided below is confidential & for professional use only.
STATE OF
COUNTY OF
NAME OF PARENT OR LEGAL GUARDIAN

First NameLast Name
RESIDING AT:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
HEREBY SWEARS OR AFFIRMS UNDER PENALTY OF PERJURY, that the following facts as stated in this document are true:
I AM THE PARENT OR GUARDIAN OF:

First NameLast Name
THE MINOR CHILD'S BIRTH DATE IS:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearMM-DD-YYYY
THE CHILD'S AGE IS:
I CONSENT TO THE BODY PIERCING OF MY CHILD AS FOLLOWS:
PHONE NUMBER
Format: (000) 000-0000.
EMAIL
example@example.com
OPT IN TO RECEIVE MARKETING TEXTS/ EMAILS FROM GOOD PAIN ARTWORKS?
I acknowledge by signing this Release I have been given the full opportunity to ask any and all questions which I might have about obtaining a piercing from Amanda Musgrave (known as the “Piercer”) and all my questions have been answered to my full and total satisfaction. In consideration of my child receiving a body piercing from Good Pain Artworks including its artists, associates, apprentices, agents, or any employees (hereinafter referred to as the "Tattoo Studio"). I acknowledge I have been advised of the matters set forth and I agree to the Minor Body Piercing Consent Form filled out by my child.
DATE OF APPOINTMENT

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
SIGNED DATE

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
SIGNATURE OF PARENT/ LEGAL GUARDIAN
Should be Empty:

CLIENT INFORMATION