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w 0 a7rent/g-� uar&Pian Vonsent Po"n |&4POR4NT| This form MUST be signed buthe Pament/Guardian* at No Exceptions! Must have VALID IDENTIFICATION! CONSENT OFPARENT 0RGUARDIAN FOR APIERCING | ,on , hereby acknowledge: (name) (date) That | 8mnthe Panent/Guardion*of (hereinafter "underage client") (name) and he/she isunder the legal age ofeighteen Vears. That the underage client has advised nme that he/she wishes to have a BodyPiercing on his/her body,and that I understand that this body piercing is temporary and not permanent. |aoknovx|edge that I am aware that the application of a body piercing includes the breakage of skin and insertion of jewelry,which is foreign to the body. I am aware that this application carries inherent risks of complicating factors such as possible infection and scarring,and I agree that all the mentioned risks are voluntarily assumed. I understand that a piercing of a mucus membrane tissue(lip,tongue,septum, nostril)can have ahigher risk mfinfection and that should aninfection develop that medical attention may benecessary. That I hereby give my consent for the insertion of body jewelry to the above named youth.That I hereby release and forever discharge ndi1semnp|oyeeypastorpresen1fronoa|| claims,demands, damages and actions arising from the application ofthis body piercing. Further, without inany way limiting the above release, Ine|ease from any liability _LA- from any medical problems which may arise from infection or any other related problem due to the insertion ofjewelry. Dated ,at inthe Otyof��an1eca (priotednanneofpierced: (signature ofpiercer): Panent/Lega| Guanjian* Signature-I19302(b): Minor's Signature: * Guardian MUST provide documentation verifying that they are the legal guardian mf the"Underage Client," minor. �� C," ,onq 03idp �� Z7,racks F~ �� i �7- tt � �� F" ' ro s*ona . a oo�n ��n � . /�ru/ng