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NOTARIZED CONSENT FOR PIERCING OF A MINOR

I hereby state that I am the legal parent of the below named and I give consent to a body piercing procedure to be performed at CLOCKWORK TAT2 Inc on the date shown herein:

Parents First & Last Name *

Child’s First & Last Name *

Parents Date of birth *

Phone *

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

Email *

Date

Notary here