Letter of Consent to Pierce my Minor Child

I, ____________________________ _______________________________________do certify that I am the legal guardian of the minor child

___________________________________________________________________ and hereby give my consent to induce David Kenneth Wilkins/The Axiom and his employees and/or Agent to preform a

_____________________________________ piercing on ________________________ _______. 201____.

Minor's Legal Guardian Signature _____________________________________________________________

Date _________________ _______, 201____

Relationship to the Minnor_ ________________________________________________________________