Minor Piercing Consent Form

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Minor Piercing Consent Form

A 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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Last updated September 16th, 2024

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A 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

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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]

Sources

  1. PEN Code 652(a)
  2. § 1114(a)
  3. § 381.0075(7)
  4.  § 65-1953
  5. § 211.760(3)(d)
  6. § 44-32-120(a)