Date *

MM

DD

YYYY

Name *

First Name

Last Name

Phone *

Country

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By checking the boxes, I agree as follows: *

I am 19 years of age or older & have provided my Tattooist with proof of ID

I do not have hepatitis B/C, HIV-AIDS, or any other communicable disease or heart condition

I have not been sick, or in direct contact with anyone that has been sick in the last 5 days

I have advised my Tattooist of any medication I am taking which thins the blood or effects the heart

I am not pregnant, and if nursing I have informed my Tattooist

I do not have any medical or skin conditions that may interfere with the tattoo procedure, in the area to be tattooed

I have informed my Tattooist of any & all allergies I may have

I acknowledge that it is not possible for my Tattooist to determine whether I might have an allergic reaction to pigments, supplies or processes used in my tattoo

I acknowledge that infection is possible for obtaining a tattoo, particularly in the event that I do not maintain proper aftercare

I agree that any touch up work required, due to my own aftercare negligence, will be done at my own cost

I acknowledge that a tattoo is a permanent change to my appearance

I acknowledge that hand-poked tattoos are likely to appear imperfect and that this is part of the interest in this particular form of tattooing

I consent to the application of the tattoo and to any actions the Tattooist deems reasonably necessary to perform the tattoo procedure

I declare that I am not under the influence of drugs or alcohol

I agree that the Tattooist reserves all rights to use any photos taken of the tattoo

I consent to my Tattooist humming and/or singing badly, for some or all, of my tattoo procedure

I agree that I have read the Tattoo Consent Form & agree to its terms