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Name *

First Name

Last Name

Preferred Name

First Name

Last Name

Date of Birth *

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DD

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

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Please consent if 18+ *

I acknowledge I am over the age of eighteen and that I have truthfully represented to my tattooer that the obtaining of a tattoo is by my choice alone. I consent to the application of the tattoo and to any actions or conduct of the representatives and employees of the tattoo shop reasonably necessary to perform the tattoo procedure.

Yes

No

1. Please Read Thoroughly *

If I have any condition that might affect the healing of this tattoo, including but not limited to: heart disease, seizures, diabetes, skin disorders, infections or blood conditions; I will advise my tattooer. I am not pregnant or nursing. I am not under the influence of alcohol or drugs.

Yes

No

2. Please Read Thoroughly *

I do not have medical or skin conditions such as but not limited to: acne, scarring (Keloid) eczema, psoriasis, freckles, moles or sunburn in the area to be tattooed that may interfere with said tattoo. If I have any type of infection or rash anywhere on my body, I will advise my tattooer.

Yes

No

3. Please Read Thoroughly *

I acknowledge it is not reasonably possible for the representatives and employees of this tattoo shop to determine whether I might have an allergic reaction to the pigments or processes used in my tattoo, and I agree to accept the risk that such a reaction is possible.

Yes

No

4. Please Read Thoroughly *

I acknowledge that infection is always possible as a result of the obtaining of a tattoo, particularly in the event that I do not take proper care of my tattoo. I have received aftercare instructions and I agree to follow them while my tattoo is healing. I agree that any touch-up work needed, due to my own negligence, will be done at my own expense.

Yes

No

5. Please Read Thoroughly *

I realize that variations in color and design may exist between any tattoo as selected by me and as ultimately applied to my body. I understand that if my skin color is dark, the colors will not appear as bright as they do on light skin.

Yes

No

6. Please Read Thoroughly *

I understand that if I have any skin treatments, laser hair removal, plastic surgery or other skin altering procedures, it may result in adverse changes to my tattoo.

Yes

No

7. Please Read Thoroughly *

I acknowledge that a tattoo is a permanent change to my appearance and that no representations have been made to me as to the ability to later change or remove my tattoo. To my knowledge, I do not have a physical, mental or medical impairment or disability which might affect my well being as a direct or indirect result of my decision to have a tattoo.

Yes

No

8. Please Read Thoroughly *

I consent to thoroughly examining the drawing my artist presents to me and the stencil which will be put on my skin. I agree to check spacing, design, spelling, dates and any other elements to which particular attention MUST be paid. I consent to my artist tattooing such stencil and understand that any errors pertaining to the design are not the liability of the artist. This is in regards to such particular details as mentioned above and I still consent to the understanding that a stencil/drawing is not a tattoo and the final products of my tattoo may vary within reason in appearance due to the execution of the art of a tattoo.

Yes

No