Minor Tattoo Consent Form
This form is for parents or guardians to provide consent for a minor to undergo a tattoo procedure. Minor will still have to fill out their own consent form
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Please upload parent and minor identification
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Minor's Full Name
*
First Name
Middle
Last Name
Parent/Guardian's Full Name
*
First Name
Middle Name
Last Name
Relationship to Minor
*
Address
*
Street Address
Street Address Line 2
City
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State / Province
Postal / Zip Code
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Minor's Date of Birth
*
-
Month
-
Day
Year
Date
Consent and Agreement
By submitting this form, you agree to the tattoo of the minor as specified.
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