Written Notarized Consent for Tattoo of a Minor
Soulshine
6025 Taylor Road #102
Punta Gorda, FL 33950

County of __________________________

Before me this ___________ Day of ______________, 20____.

Personally Appeared _________________________________, 		(Name of Parent/Guardian)

Who, Under oath or affirmation, makes the following statement under penalties of perjury:
I am the Parent/Legal Guardian of ________________________________ 				             (Name of Minor)

a minor, whose date of birth is __________________, __________, ______
					(Month)	  (Day)		 (Year)

And I consent to the tattoo of _____________________________'s 					     (name of Minor)
__________________________ . (Location of  Tattoo)

I accept that I must be present at the time of the piercing if my child is under 16 years of age.

_____________________________________ (Signature of Parent/Legal Guardian)

I agree to release and forever discharge and hold harmless Soulshinepg LLC./ PGSoulshine from any and all claims, damages and legal actions arising from or connected in any way with his/her tattoo, or with the procedure and/or conduct used during his/her tattoo.

Sworn to/Affirmed and subscribed before me this _________ day of _________, 20_____.

By _______________________, Who is personally known to me or presented

________________________________ as satisfactory identification.
			        (Form of Identification)

Notary seal:	

					_____________________________ 					(Signature of Notary)         

									_____________________________
(Name of Notary type, stamped or printed)

Office Use Only

  __________________________     ___________________
           (Printed name of Artist)		 (Printed name of Licensed studio)

____________________				
	(Signature of  Artist)