Help Little Pricks Tattoo Prepare for Your Session

Piercing Parental Consent Affidavit

MINOR BODY PIERCING CONSENT AND ACKNOWLEDGMENT OF RISK

Little Pricks Tattoo
11815 North FM 620 #5
Austin, TX 78750
State of Texas County of Williamson

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

This 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.

You are hereby notified of the possible risks and dangers associated with receiving a body piercing. These risk and dangers include, but are not limited to, at least the following:

I. The possibility of discomfort or pain;
II. The possibility of scarring;
III. The possibility of bleeding;
IV. The possibility of swelling;
V. The risk of infection;
VI. The possibility of nerve damage; and
VII. The increased risk for adolescents during certain stages of development.
VIII. An undesired outcome of the body piercing.

NO PERSON MAY BE BODY PIERCED WHO APPEARS TO BE UNDER THE INFLUENCE OF ALCOHOL OR DRUGS.

Piercing Aftercare Information

An artist may not perform body piercing on a person younger than 18 years of age without the consent of a parent, managing conservator, or guardian.

By signing this form, you affirm that you have read, understood, and agreed to the above terms.

Agreement of Terms

Checking this box means that you agree to the terms stated above.*

Piercing Aftercare Confirmation

I have read and understood the piercing aftercare information.*

Are you okay with your child's piercing session being recorded and used for our social media platforms?

okay is your

Name of Minor to be Pierced

First

Last

Name of Parent, Managing Conservator, or Guardian

First

Last

Phone

What's is the Minor's Age?

Minor's Birthday

Choose your piercer

Kenny
Kyle

Upload a Record of the Minor's Identity.

Drag & Drop Files, Choose Files to Upload

File Types Allowed: PNG, GIF, JPG, PDF • 1 File Only

Upload a Record of the Parent, Managing Conservator, or Guardian's Identity.

Drag & Drop Files, Choose Files to Upload

File Types Allowed: PNG, GIF, JPG, PDF • Max File Size: 12 MB • 1 File Only

Other Materials Demonstrating the Status of the Parent, Managing Conservator, or Guardian must be Recorded.

Drag & Drop Files, Choose Files to Upload You can upload up to 3 files.

File Types Allowed: PNG, GIF, JPG, PDF • Max File Size: 6 MB • 3 Files Max

Form Confirmation

I confirm that the information given in this form is true.*

Conditions Confirmation

I understand deposits, tattoos, or procedures are non-refundable.*

Electronic Consent of Parent, Managing Conservator, or Guardian

By typing your full name above, you agree this constitutes your electronic signature.

Kyle

Tita

Noah

Bishop

Skye

Carlos