Body Designs

1739 Deer Park Avenue, Deer Park NY 11729(631) 254-8288

Body Piercing Parental Consent Form

I, ___________________ am the legal parent/guardian of __________________ (minor child) and do hereby give notarized permission to Body Designs to perform the following piercing:

 ________________.

I understand that there are certain risks associated with having a body piercing performed and I understand that a piercing of a mucus membrane tissue (lip, tongue, septum, nostril) can have a  higher risk of infection and that should an infection develop that medical attention may be necessary.

I acknowledge that I will take full responsibility and insure that the proper aftercare is followed.  Also I will not hold Body Designs responsible in any way.

Parent or Guardian (print name): _____________________

Parent or Guardian (signature):______________________

Date: ____/_____/______

Notary (print name):______________________

Notary (signature):______________________

Date: _____/_____/_______

Notary Stamp:

*Piercing must be done within 30 days of date of notarization.

*Void after 30 days.