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iercing Contract <br /> 21. 1 hereby give my full consent MO bUffand its <br /> employees to take the measures necessaryto develop and complete <br /> the Piercing, including the right e in contact with the area(s) I <br /> wish to be Pierced Y / <br /> . 1 agree to the statedise of $ for the Piercing. <br /> 23. 1 release J&Mf SDO OF AZO hiMand it's employees from any legal <br /> liability concerning Piercing(s) i / <br /> Please Print Clearly: <br /> Name: Appt.Date:_J_J_ <br /> Address: <br /> City: i <br /> Work : <br /> Date of Birth: / <br /> If applicable, describe reason for denial of service requested by client. <br /> Signature— <br /> * Required by San Joaquin Environmental Health Department <br />