Little Pricks Tattoo

Parental Consent Affidavit

BODY PIERCING PARENTAL CONSENT AFFIDAVIT

11815 North FM 620 #5

Austin Tx, 78750

512-436-8230

State of Texas County of Williamson.

Under penalty of perjury, I, the undersigned, declare the following:

• is my minor child.

• I have the authority to consent to the body piercing of my child.

• I have presented identification of myself and my minor child to

the manager/artist of this establishment.

• I agree to remain present with my minor child during the

entire procedure of body piercing.

Full name of Minor to be pierced

Full Name of Parent, Managing Conservator, or Guardian

What is the minor's age?

Phone Number

Upload a record of the minor's identity.

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Birthday

Upload a record of the parent's identity.

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Other materials presented demonstrating the status of the parent, managing conservator, or guardian must be recorded.

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Signature of Parent, Managing Conservator, or Guardian