A Bravenet.com Contact Form

Minor Piercing Consent Form - Largo FL

By submitting this form, I agree to all all terms and hereby give consent for the piercing artist named below to perform a piercing on me. I release the tattoo and piercing establishment named below and the piercing artist from any and all manner of liabilities, claims, actions and demands in law, or in equity, which I or my heirs might now or hereafter by reason of complying with my request of a piercing. I understand that any employee or independent contractor of the named establishment, when performing a piercing does not act in the capacity as a medical professional. The suggestions made by any employee or independent contractor of the named establishment are just suggestions. They are not to be construed as or substituted for advice from a medical professional. I understand that the piercing will be performed using appropriate techniques and instruments. I also understand that infections can occur due to lack of proper aftercare hygiene and/or jewelry sensitivities. To ensure proper healing of my piercing, I agree to follow written and/or verbal aftercare instructions that will be provided until healing is complete. I understand that a piercing may take several months to heal properly.

Date *

Parent or Legal Guardian's Name *

Minor's Name *

Minor's Birthday * date_range

Email Address *

Phone *

Race *

Sex * Biological male Biological female

Physician Name *

Physician Address *

Physician Phone *

Minor's Emergency Contact Name

Emergency Contact Address *

Emergency Contact Phone *

Minor's Medical Conditions *

Minor's Allergies *

Piercer's Name *

Type of Piercing *

Location of Piercing *

Description of Jewelry *

Select "Camera" and photograph your notarized Minor Piercinng Consent Form, your photo I.D. and the minor's I.D. together in 1 photograph. *

Piercing Artist's Digital Signature *

I agree and understand that by signing the Electronic Signature Acknowledgment and Consent Form, that all electronic signatures are the legal equivalent of my manual/handwritten signature and I consent to be legally bound to this agreement. * I agree

Parent or Legal Guardian's Digital Signature *