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Minor Piercing Consent Form Template

Ensure Proper Consent for Minors' Piercing Procedures

Performing body piercings on minors can be a complicated process, and securing proper consent is crucial. This Minor Piercing Consent Form template helps you obtain clear permission from parents or guardians before the procedure. With this template, you'll facilitate safety, improve communication with guardians, and streamline the consent process in your shop. Plus, it's designed with WCAG-aligned labels to ensure accessibility. Discover how easy it is to protect both yourself and your young clients with our readily available template.

Use this Template (FREE) Live Preview
Minor full name
Date of birth
If self-describing, please enter gender
Home address (street, city, state, ZIP)
Gender identity
Woman
Man
Non-binary
Prefer to self-describe
Prefer not to say
Parent/guardian full name
Relationship to minor
Parent
Legal guardian
Other
Please Specify:
If Other, please specify relationship
Parent/guardian phone number
Parent/guardian email address
Parent/guardian home address (street, city, state, ZIP)
Government-issued ID number (parent/guardian)
Government-issued ID type (parent/guardian)
Driver license
Passport
State or territory ID card
Military ID
Other
Please Specify:
Area(s) to be pierced
Please Specify:
Side
Left
Right
Both
Not applicable
Desired jewelry size/gauge (if known)
Studio/practitioner name
Appointment date
Prior piercing history or complications
Jewelry material preference
Implant-grade titanium
Surgical steel
14k or higher gold
Niobium
Bioplastic/PTFE
Unsure/decide at studio
Known allergies
Nickel
Cobalt
Latex
Adhesives/Tape
Lidocaine or local anesthetics
Antiseptics (e.g., iodine, chlorhexidine)
Antibiotics
None
Other
Please Specify:
If Other allergy, please describe
Current medications (including blood thinners, acne medications, steroids)
Current or past medical conditions
Alcohol or recreational drugs in the last 24 hours
Yes
No
Prefer not to say
Currently unwell or taking antibiotics
Yes
No
Not sure
Emergency contact full name
Emergency contact phone number
Emergency contact relationship to minor
Consent to provide first aid if needed
Yes
No
I understand potential risks may include
I have received and understand written aftercare instructions for this piercing
Yes
No
Parent/guardian initials to confirm receipt of aftercare information
I agree to follow all aftercare instructions and will seek medical advice if needed
Yes
No
I am the parent or legal guardian of the minor named above
Yes
No
I authorize the piercing(s) described to be performed on the minor
Yes
No
I confirm the information provided is accurate and complete
Yes
No
I acknowledge that outcomes are not guaranteed and service fees are non-refundable
Yes
No
I grant permission for photographs or videos of the piercing to be used for the studio portfolio/marketing (no names shared)
Yes
No
Parent/guardian printed name
Parent/guardian electronic signature (type full legal name)
Parent/guardian signature date
Minor printed name
Minor electronic signature (type full legal name, if applicable)
Minor signature date
Staff member/witness name
Witness date
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Paper art illustration related to minor piercing consent form template for FormCreatorAI article

When to use this form

Use this template when a parent or legal guardian must approve a piercing for someone under 18. It suits studios that need to verify age, capture health info, and document consent before a lobe, cartilage, or nostril piercing. It also helps when a guardian cannot attend but must sign in advance, or when you run busy walk-in hours and need a fast, compliant intake. For risk and release language, you can pair it with a Client consent waiver form. For broader service permissions across your business, adapt a Client consent form. The result: clear records, fewer delays at the counter, and protection for your shop and the family.

Must Ask Minor Piercing Consent Questions

  1. Are you the minor's parent or legal guardian, and do you consent to the specific piercing requested?

    This confirms you have authority to approve the procedure and creates a clear, lawful record of consent. It reduces disputes and protects you and your studio from avoidable liability.

  2. What is the minor's full legal name and date of birth?

    Accurate identity and age help you meet local age restrictions and prevent errors. It also ensures your records match IDs and insurance or incident reports, if needed.

  3. Which government-issued photo ID will you bring for yourself, and what proof of guardianship can you provide?

    Verifying identity and guardianship prevents fraud and keeps you compliant with state and local rules. It speeds check-in because staff know exactly what documents to expect.

  4. Does the minor have any medical conditions, allergies, or medications we should know about?

    Medical history screening, as used in a Dental implant consent form, flags risks like bleeding issues or metal allergies before the procedure. Explaining how you protect this data, similar to a Counseling confidentiality form, builds trust and encourages full disclosure.

  5. Which piercing is requested, and do you acknowledge the procedure risks and aftercare instructions?

    Clear agreement on the exact service, risks, and aftercare reduces complications and follow-up disputes. Strong risk language, like the clarity shown in a Professional counseling informed consent form, improves understanding and outcomes.

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