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Tattoo Release English

Let us do this part
Today's Date:
Thu Apr 25 2024 10:27
Practitioner:*
Tattoo Consent and Release Form
Please read and answer
*
I understand that there are risks associated with getting tattooed, and those risks include but are not limited to: allergic reaction, infection, scarring, difficulty detecting melanoma, and feeling dizzy/lightheaded during or after the procedure and fully accept any and all risks.
 
Chosen Name if Different from Legal Name
 
 
Tattoo Design
 
 
How did you hear about us?
 
 
Tattoo Placement on Body
 
Healing*
The artist and studio have made available instructions on the care of my tattoo while it is healing, and I understand and will follow them. I understand that the tattoo can become infected, particularly if i do not follow instructions.
Influence*
I am not under the influence of alcohol or drugs, and am consenting to be tattooed by the artist without duress or coercion.
Health*
I do not currently have diabetes, epilepsy, hemophilia, a heart condition, nor am I on blood thinning medication. I am not the recipient of a recent transplant. I am not pregnant or nursing. I do not have a mental impairment that may affect my judgement in getting the tattoo.

OR if any of these conditions apply to me, I have disclosed them to my artist and discussed the additional effects to my tattoo they may have.
Design Factors*
Neither the artist nor the studio is responsible for the meaning, spelling, or symbolism associated with my tattoo design. Neither the artist not the studio is responsible for accurately translating a phrase in another language.

I agree that my artist and I will come to an agreement regarding the final design and the placement of the tattoo and that it is my responsibility to let the artist know if I want the placement changed.
Fading and Permanence*
I understand that variations in color, design, and application of the tattoo, as well as factors such as time, sun exposure, healing, may cause fading in my tattoo

I also understand that while tattoos can fade, tattoos are a permanent procedure that can only be removed by laser or surgical means
Y
N
Bloodborne Pathogens*
Do you have any bloodborne pathogens, transmittable diseases, or recent illnesses? If so, please advise your artist.
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.
Client Information
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.