Parental Consent Form

First name* Last name* Birthday* Date and Time of Procedure* Name of Operator* Adult's Relation to Minor*

I acknowledge by signing this release form that I hereby release Eternal Gold Ltd and its employees and agents from all manner of liabilities, claims, actions, and demands, in law or in equity, which I or my heirs have or might have now or hereafter by reason of complying with my request to pierce by child. I certify that I am the parent or legal guardian of the minor receiving the piercing and/or tattoo. I agree that I will assume all responsibility for any medical, legal, or other situation resulting from my request to pierce/tattoo my child. I understand that I must remain in the presence of this minor during piercing/tattooing procedures. I understand that my child will be pierced/tattooed using appropriate instruments and techniques. I understand that this type of piercing usually takes a minimum of the estimated period of time or longer to heal.

Estimated Healing Time* I certify under penalty of perjury that the information herein is true and correct. Adult's Signature*

Clear

I certify under penalty of perjury that the information herein is true and correct. Minor's Signature*

Clear

How is Your Experience So Far?*