Skin Piercing Consent Form by vxy31343

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									                 Skin Piercing Consent Form                                                Skin Piercing Consent Form
To be filled in clearly and correctly by persons wishing to be pierced.   To be filled in clearly and correctly by persons wishing to be pierced.

Name:        _________________________________________________            Name:         ________________________________________________

Address:     _________________________________________________            Address:      ________________________________________________

Telephone: _________________________________________________              Telephone:    ________________________________________________

Age:         _________________________________________________            Age:          ________________________________________________


This is to certify that I, the above named and undersigned, today         This is to certify that I, the above named and undersigned, today
gave my correct name, address and age when asked to do so by              gave my correct name, address and age when asked to do so by

This is to certify that, the above named and undersigned, do give         This is to certify that, the above named and undersigned, do give
my permission to be pierced and I am fully aware of the process           my permission to be pierced and I am fully aware of the process
involved and understand the importance of the daily aftercare             involved and understand the importance of the daily aftercare
procedure.                                                                procedure.


Signed:      _________________________________________________            Signed:       ________________________________________________

Date:        _________________________________________________            Date:         ________________________________________________

Where the client is under the age of 18 the parent or guardian must       Where the client is under the age of 18 the parent or guardian must
also sign.                                                                also sign.

Signed:      _________________________________________________            Signed:       ________________________________________________

Date:        _________________________________________________            Date:         ________________________________________________

Type of                                                                   Type of
Piercing:    _________________________________________________            Piercing:     ________________________________________________

             _________________________________________________                          ________________________________________________

             _________________________________________________                          ________________________________________________

								
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