NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Community Environmental Health and Food Protection
It is important to be aware of the potential health risks associated with body piercing such as allergic reactions, skin infections, hepatitis, prolonged bleeding, swelling, scarring and general discomfort. Existing medical conditions such as allergies, heart disease, diabetes, skin disorders or conditions that affect the immune system may increase the risk of complications from body piercing. Before providing consent for body piercing, speak with a physician regarding potential health risks for your child.
New York State Public Health Law Article 4-A, Section 460-a, prohibits the owner, operator or employee of a body piercing studio from body piercing a person under eighteen years of age unless a parent or legal guardian provides written consent. To provide consent, the parent or legal guardian must complete and sign this form in the presence of the owner of the body piercing studio or in the presence of the studio's body piercing specialist. The original written consent will be retained by the body piercing studio and will expire twelve months from the date it was signed.
BodMod205 S Main St Canandaigua, NY 14424Name of Legal Operator: Ran ShultzName of Body Piercing Specialist: Joe Gaudio
I have fully read this agreement, understand it, and also understand that by typing my name below I am providing my electronic signature and I consent to be legally bound by this agreement.