Tattoo Release English Release Form

Let us do this part
Today's Date:
Thu Mar 23 2023 11:56
Practitioner:*
Tattoo Consent and Release Form
Please read and answer
 
Chosen Name if Different from Legal Name
 

 
Tattoo Design
 

 
Student?
 

 
How did you hear about us?
 

 
Tattoo Placement on Body
 

 
Allergies
 

 
Medications
 

 
Medical Conditions
 

Diabetes

HIV/AIDS

Epilepsy

Asthma

Infections

Hemophilia

Blood Thinners

Heart Condition

Immune Condition

Steroid Medication

Psoriasis/Eczema

Scarring/Keloids

TB

Herpes

Hepatitis

Pregnant

Nursing

HRT
HRT can cause extra skin sensitivity, please discuss with your artist!
Positive responses to any of these questions will likely indicate a deeper discussion with your artist before proceeding with your body modification
If any provision, section, subsection, clause or phrase of this release is found to be unenforceable or invalid, that portion shall be severed from this contract. The remainder of this contract will then be construed as though the unenforceable portion had never been contained in this document.
Personal Info
I hereby declare that I am of legal age (with valid proof of age) and am competent to sign this Agreement.
Legal Name:*
Pronoun:
Chosen name:
Address:*
Postcode:
Date of birth:*
You must be 18 or older
Phone #:*
Email:
Signature:*


Photo ID*
Please take photo(s) of your government issued photo IDs and related paperwork.