Name *

First Name

Last Name

Phone

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Date of Birth *

You MUST be 18+

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General Consent and Understanding *

I acknowledge by signing this agreement that I have been given the full opportunity to ask any and all questions which I might have about obtaining a tattoo and that all of my questions have been answered to my full satisfaction.

Health and Condition Disclosure *

I am not pregnant or nursing, under the influence of alcohol or drugs, and I will advise my tattooer if I have any condition that might affect the healing of this tattoo.

I do not have medical or skin conditions such as 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.

Acknowledgement of Risks *

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 agree to accept the risk that such a reaction is possible.

I acknowledge that infection is always possible as a result of obtaining a tattoo, particularly if I do not take proper care of my tattoo. I have received aftercare instructions and agree to follow them while my tattoo is healing.

Acknowledgement of Tattoo Characteristics *

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.

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

Permanent Change Acknowledgement *

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.

Legal Age and Voluntary Participation *

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.

Consent to Procedure *

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.