Hammerhead Tattoo
Parent/Guardian Consent Release Form
Parent/Guardian Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian’s State Issued ID
*
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of
Minor’s ID/Birth Certificate
*
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of
I am the natural parent or legal guardian of:
*
Name of minor child
My child’s date of birth is:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
My child’s age is:
*
I have the legal authority to give consent for this child’s tattoo:
*
Yes/No
I consent to the tattooing of my child as follows:
*
Description/location of tattoo on child
Parent/Guardian Signature
*
Date Signed
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Submit
Should be Empty: