Tattoo Consent Form

Let us do this part

Today's Date:

Thu May 29 2025 05:41

Practitioner:*

Artist signature:*

Please read and answer

FOR NUMBING CREAM / SPRAY USE ONLY (not required)*

I am NOT using numbing cream / Spray. I am using numbing cream at my own risk. if I do not want my artist using numbing cream or spray during my session, I will be sure to notify them. I understand that most tattoo numbing creams and sprays contain more than the legal OTC lidocaine percentage and can be damaging to my skin. I Know that numbing creams/ sprays MAY cause severe skin reactions like permanent discoloration, itchiness and hives. I am aware that numbing creams may cause injury such as: irregular heartbeats, Seizures and difficulty breathing. I am aware that numbing cream may burn my skin if it is left on too long. I am aware that numbing cream/spray may or may not work. I am aware that the pain once numbing cream wears off. the pain may be doubled. I understand that most tattoo numbing creams/sprays are NOT FDA approved.

Medications taken in the last 24 hours: *

(Antidepressants, painkillers, acne medication etc.) If none, put “N/A”

Do you have any of the following blood borne illnesses?*

HIV HPV Syphilis Malaria Hep B Hep C Other transmittable disease None

Allergies*

Please list any allergies you have especially if they include latex, adhesives metals or dyes. (we don’t care about your seasonal allergies)

Tattoo Location:*

(Ie: Left Arm, Ribs, Right Thigh,)

Brief tattoo Description:*

(Ie: Winnie the Pooh riding a seahorse, “a rose” or if you're still undecided you probably shouldn't be here...) but put at least something!

Do you have any of the following Flu like symptoms?*

Fever Shortness of breath Cough Fatigue Nausea/ Vomiting Diarrhea Migraine Other None

Eaten*

Have you eaten in the past 4 hours? It's a good idea to before hand to increase your blood sugar levels. If you have not eaten, please inform your artist. We wouldn't want you to pass out. WE (usually) HAVE SNACKS unless Steve ate them all.

Risks*

That I have been fully informed of the inherent risks, associated with getting a tattoo. I fully understand that these risks, known and unknown, can lead to injury, including but not limited to infection, scarring, difficulties in detecting melanoma and allergic reactions to tattoo pigment, latex gloves, and/or soap. Having been informed of the potential risks, I still wish to proceed with the tattoo application and I freely accept and expressly assume any and all risks.

Waive*

TO WAIVE AND RELEASE to the fullest extent permitted by law each of the Artist and the Studio from all liability whatsoever, for any and all claims or causes of action that I, my estate, heirs, executors or assigns may have for personal injury or otherwise, including any direct and/or consequential damages, which result or arise from my tattoo, whether caused by the negligence or fault of either the Artist or the Tattoo Studio, or otherwise.

Healing*

The Artist and the Tattoo Studio have given me instructions on the care of my tattoo while it's healing, and I understand them and will follow them. I acknowledge that it is possible that the tattoo can become infected, particularly if I do not follow the instructions given to me. If any touch-up work to the tattoo is needed due to my own negligence, I agree that the work will be done at my own expense. I am aware any/all complimentary touch ups must be completed within one year of receiving my tattoo.

Influence*

Are you under the influence of DRUGS OR ALCOHOL?

Do you have any of the following:*

Diabetes Epilepsy Hemophilia Heart condition Psoriasis Eczema Cancer Anxiety Fungal Infection Asthma Cellulitis Herpes Cystic Fibrosis Taking blood thinning medication Have any other condition that may interfere with the application or healing of the tattoo Received an organ or bone marrow transplant Have any mental impairment None

Spelling*

Neither the Artist nor the Tattoo Studio is responsible for the meaning or spelling of the symbol or text that I have provided to them. I have proofread my tattoo and have made sure if my words are foreign that they are spelled correctly.

Fading*

Variations in color/design may exist between the art I have selected and the actual tattoo. I also understand that over time, the colors and the clarity of my tattoo will fade due to natural dispersion of pigment under the skin. I am aware that some colors may not appear as vibrant in my skin if my skin pigment is darker. I understand that if I obtain a tattoo on my hands or feet that they may fade off completely and that my artist will not offer me a complimentary touch up.

Permanent*

A tattoo is a permanent change to my appearance and can only be removed by laser or surgical means, which can be disfiguring and/or costly and which in all likelihood will not result in the restoration of my skin.

Legal Action*

I agree to reimburse each of the Artist and the Tattoo Studio for any attorneys' fees and costs incurred in any legal action I bring against either the Artist or the Tattoo Studio and in which either the Artist or the Tattoo Studio is the prevailing party. I agree that the courts of New Jersey in the United States shall have personal jurisdiction and venue over me and shall have exclusive jurisdiction for the purpose of litigating any dispute arising out of or related to this agreement.

Questions*

I acknowledge that I have been given adequate opportunity to read and understand this document, that any and all of my questions have been answered, that it was not presented to me at the last minute, and I understand that I am signing a legal contract waiving certain rights to recover against the Artist and the Tattoo Studio.

Photography

I release all rights to any photographs taken of me and the tattoo and give consent in advance to their reproduction in print or electronic form. (If you do not tick this provision, please advise your Artist).

Deposit Disclosure *

I am aware that all deposits are non-refundable and will be forfeited if I arrived 20+ minutes late, change my tattoo idea the day of or if I have to cancel my appointment. I know that if I need to reschedule I will give my artist at least 7 days notice.

Pregnancy*

Are you currently Pregnant or Nursing?
By Law, we can-not tattoo those who are Pregnant.
The risk of infection could result in pregnancy loss.
those who are breast feeding would not be able to take any antibiotics for infections if they were to occur.

Taxes and Fees*

I Understand that there are extra Taxes and Fees when paying with a Credit/Debit Card and that Cash payments can be significantly cheaper. I Understand that if I need to go to an ATM I will notify my artist -before- the procedure to get a better idea on how much my tattoo will cost.

Deposit Information *

Did you place a deposit for your tattoo appointment? If so; how much?

Details:

Please verbally notify your artist of any known allergies - especially to latex or adhesives.

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 or, if not, that my parent or legal guardian shall sign on my behalf, and that my parent or legal guardian is in complete understanding and concurrence with this agreement.

Legal Name:*

Chosen name:

Address:*

Postcode:*

Date of birth:*

If you are under 18 your parent/guardian will be required

Phone #:*

Email:*

Signature:*

Sign above or type signature:

Emergency Contact

If something happens, your emergency contact might need to explain your medical history, allergies, or medications.

Name:

Phone #:*

Photo ID*

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