777 South 3rd St.
Jacksonville Beach, FL 32250
December 15, 2018
BODY PIERCING CONSENT FORM
In accordance with Florida state law, any individual receive a body piercing MUST present valid government-issued ID.
For minors receiveing a piercing:
For the following question, please select "Beaches Baptist" if you do not have a personal physician you'd like to list.
For the following fields, if none apply, please write in "N/A" or "None"