"I, the undersigned, certify that I am the parent, legal guardian, or legal custodian of the named minor and further give consent to the body piercing procedure(s) as explained. I acknowledge that I am fully aware that to falsify my legal standing as to being the minor's parent, legal guardian or legal custodian constitutes a Class C misdemeanor. A Class C misdemeanor means imprisonment for not greater than thirty (30) days or a fine not to exceed fifty dollars ($50.00) or both. (T.C.A. 40-35-111)."
Tenn. Comp. R. & Regs. 1200-23-06-.03
Authority: T.C.A. §§ 4-5-202 and 62-38-101 et seq.