Piercing Form

MINOR Piercing Consent Form

THE DOLOROSA TATTOO CO.
11930 Ventura Blvd, STUDIO CITY, CA 91604
RELEASE AND CONSENT FOR PIERCING
PLEASE READ AND BE CERTAIN YOU UNDERSTAND THE IMPLICATIONS OF SIGNING.

NAME OF PIERCER: PLEASE ENSURE THAT THE PIERCER'S NAME IS SPELLED CORRECTLY
- STEPH DEVOTCHKA
- MARV SANTOS AFFIRMATION:
I/We affirm that the following facts as stated in this document are true:

That I/We (am/are) the natural parent OR LEGAL GUARDIAN (Parent Or Legal Guardian Must PROVIDE proper identification or proof of having legal authority to give consent to the body piercing of this minor.

Name of Parent or Legal Guardian:Phone Number:Today's Date:

LEGAL IDENTIFICATION OF PARENT OR GUARDIAN:

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Name of Minor Child:Minor Child's Date of Birth:Minor Child's Current Age

LEGAL IDENTIFICATION OF MINOR CHILD:

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Location of Piercing (check with piercer):

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PLEASE NOTE THE FOLLOWING:

PARENT/GUARDIAN MUST BE PRESENT AT ALL TIMES DURING BODY PIERCING PROCEDURE.
PARENT/GUARDIAN MUST ENSURE THAT THE AFTERCARE INSTRUCTIONS FOR THE MINOR’S PIERCING IS BEING FOLLOWED

Check to confirm the Following:

I/WE, Have received written Aftercare ProcedureToday's Date

The information I have provided is complete and true to the best of my knowledge.
I HAVE READ THIS AGREEMENT, I UNDERSTAND IT, AND BY SUBMITTING I AGREE TO BE BOUND BY IT.

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