Minor Piercing Consent Form

minor piercing consent form is used by piercers to obtain parental permission before performing a piercing on a minor. The document should include the name of the parent or legal guardian, their signature, the child’s age, and the location and type of piercing.

Minor Piercing Consent Form

minor piercing consent form is used by piercers to obtain parental permission before performing a piercing on a minor. The document should include the name of the parent or legal guardian, their signature, the child’s age, and the location and type of piercing.

Last updated September 16th, 2024

minor piercing consent form is used by piercers to obtain parental permission before performing a piercing on a minor. The document should include the name of the parent or legal guardian, their signature, the child’s age, and the location and type of piercing.

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State Specific Forms

Some states provide their own recommended consent forms for the piercing of a child.

 

Florida Piercing Consent Form – Florida parents can use this form provided by the Department of Health to give permission for piercing their children.

 

Download: PDF


New York Piercing Consent (Form 5072) – A form provided by the NYDOH for consent to pierce a minor.

 

Download: PDF


Texas Body Piercing Parental Consent Affidavit – A piercing consent form provided by the Texas Department of State Health Service.

 

Download: PDF
 

Notarization

Some states require the parent/guardian’s signature on the consent form to be acknowledged before a notary:

  • California (unless the parent is present during piercing)[1]
  • Delaware[2]
  • Florida[3]
  • Kansas[4]
  • Kentucky[5]
  • South Carolina (unless the parent is present during piercing)[6]

Sample

Download: PDF, MS Word, OpenDocument

MINOR (CHILD) PIERCING CONSENT FORM

State of [STATE]
County of [COUNTY]

[NAME OF PARENT OR LEGAL GUARDIAN]
Parent/Legal Guardian Name

Residing at: [ADDRESS]

HEREBY SWEARS OR AFFIRMS UNDER PENALTY OF PERJURY, that the
following facts as stated in this document are true:

  1. I am the natural parent or legal guardian of: [NAME OF MINOR CHILD]
  2. My child’s date of birth is: [MM/DD/YYYY]
  3. My child’s age is: [AGE]
  4.  I have the legal authority to give consent to the body piercing of this child.
  5. I consent to the body piercing of my child as follows: [LOCATION OF PIERCING ON MINOR CHILD].

Parent / Legal Guardian Signature: ____________________________ Date: [MM/DD/YYYY]
Print Name: [PARENT/GUARDIAN PRINTED NAME]