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Tattoo Release Form Lexington
Let us do this part
Today's Date:
Tue Jun 9 2026 02:54
Practitioner:*
Tattoo Location:*
Tattoo Subject:*
Tattoo Charlie's Lexington Tattoo Consent Form
Photo Identification *
Please take photo(s) of your government issued photo IDs and related paperwork
Please read and answer
Y
N
Have you eaten in the past 4hrs? It\'s a good idea to before hand to increase your blood sugar levels.
I acknowledge I am not pregnant.
I attest to the fact that I am not intoxicated or under the influence of drugs or alcohol.
I acknowledge I have truthfully represented to the associates, agents, and representatives of Tattoo Charlie\'s of KY, Inc. that I am 18 years of age or older.
That I have been fully informed of the risks, associated with getting a tattoo. I understand that these risks, known and unknown, can lead to injury, including but not limited to infection, scarring and keloiding, and allergic reactions. Having been informed of the potential risks associated with getting a tattoo, I still wish to proceed with the tattoo and I freely accept all risks that may arise from the tattoo.
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, whether caused by the negligence or fault of either the Artist or the Studio, or otherwise.
That both the Artist and the Studio have given me the full opportunity to ask any and all questions about the tattoo procedure and the they have been answered to my total satisfaction.
Tattoo Aftercare Instructions\r\n\r\n1. DO NOT remove your bandage for a full 24 hours. No peeking!\r\n2. Wash your new tattoo in the shower with a mild soap and your hand only.\r\n3. Run cold water over your new tattoo for 5 full minutes. This helps close the pores and brighten the colors.\r\n4.Apply a small amount of the ointment provided 3 times a day for two weeks. Less is better!\r\n5. Keep your new tattoo out of the sun and tanning beds for a full 2 weeks.\r\n6. No swimming pools, hot tubs, or baths for two weeks. Take short showers.\r\n\r\nIf you follow these instructions your tattoo will heal perfectly in no time!\r\n\r\nIf signs and symptoms of infection such as fever, excessive swelling, excessive redness, or drainage occur, please consult a physician.\r\n\r\nYou will receive these written as well at the end of your tattoo.
I affirm that I have given me instructions on the care of my tattoo while it is 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.
I acknowledge that the tattoo will result in a permanent change to my appearance.
According to health department requirements, I have not taken a blood thinner within the last 24 hours.
Y
N
In the case where I give consent to my tattoo being photographed, 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.
We will not use your contact information (other than email) for any purpose other than records keeping as required by the Kentucky Department of Health Services. It will not be sold to any third party.
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:*
Chosen name:
Address:*
Postcode:
Date of birth:*
 
You must be 18 or older
Age: 
Phone #:*
Email:
Signature:*