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Tattoo Release English Release Form
Let us do this part
Today's Date:
Thu Mar 23 2023 11:56
Practitioner:
*
-- Select --
Mark Keller
Shawn Franklin
Christine Houston
Naomi Burdick
Anna Crow
Lucid
Raven
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:
-select-
He/Him
She/Her
They/Them
He/Them
She/Them
He/She
He/She/They
Chosen name:
Address:
*
Postcode:
Date of birth:
*
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You must be 18 or older
Phone #:
*
Email:
Signature:
*
Sign above or type signature:
Parent/Legal Guardian
I, as custodial parent or legal guardian of the above minor under -18 years of age, hereby consent to the terms and conditions set forth in this release form and I attest that all documentation I have provided is true and accurate.
Guardian's Legal Name:
*
Signature:
*
Photo ID
*
Please take photo(s) of your government issued photo IDs and related paperwork.
Remove Photo