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S NAME ADDRESS SUBURB PHONE P/CODE EMAIL AGE If signing for an under 18 year old, are you their PARENT? LEGAL GUARDIAN? Licence number details YOUR NAME YOUR LICENCE NUMBER I.D. sighted Confidential Information (discuss each question with the piercer) Please circle .. yes or no .. correctly I am 18 years of age or older or have parental consent for this piercing Have you eaten within the past 4 hours Have you been drinking alcohol within the last 8 hours Are you currently taking any .

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