Atomic Tattoos & Body Piercing                      
Corporate: 9041 Ulmerton Rd, Largo, FL 33771
Studio # & Location: ____________________
Addres: ______________________________
City: _____________ State: ___ Zip: _______
Phone:_______________________________

A person may not perform body piercing on a minor without the written notarized consent of the parent or legal guardian, and an establishment may not perform body piercing on a minor under the age of 16 unless a parent or legal guardian accompanies the minor.  Atomic Tattoos and/or contractors may refuse service to any minor and therefore this does not constitute a right or contract to receive service.

I,_________________________, give legal permission for my child/ward, ____________________, to  have a ____________ (left or right, if applicable) piercing at Atomic Tattoos.

Parent/Legal Guardian signature______________________ Date_______________
Identification type and number____________________________

Notary Signature
The foregoing instrument was acknowledged before me this_____
day of_______________, 20____, by______________________, who is(  ) personally know to me or (   ) who has produced _______________________ as identification and who did not take an oath.

This section is to be filled out at the time of piercing if the minor is under age 16.
I,_____________________ the parent/legal guardian of________________________ was present at the time of the piercing.

Parent/Legal Guardian signature_____________________________
Piercer’s signature_________________________________________