Halfway House Tattoo Consent Form

Let us do this part

Today's Date:

Sat Oct 24 2026 10:50

Practitioner:*

Please read and answer

By completing this form, I hereby consent to being tattooed by my chosen artist.
Please carefully read and confirm your understanding of the following points by placing a
checkmark beside each one. If you have any questions or concerns, consult a representative or
independent contractor of Halfway House Tattoo.

I acknowledge that obtaining my tattoo is by my choice alone and I consent to the application of the tattoo
and to any action or conduct of the independent contractors and representatives of Halfway House
Tattoo necessary to perform the tattoo procedure.

I acknowledge that it is not reasonably possible for the representatives and independent contractors of
Halfway House Tattoo to determine whether I might have an allergic reaction to the pigments or process
used in my tattoo, and I agree to accept the risk that such a reaction is possible.

I acknowledge that infection is always possible as a result of obtaining a tattoo, particularly in the event
that I do not take proper care of my tattoo. I agree to follow the aftercare suggestions provided verbally
until healing is complete. I agree that any touch-up work required because of my own negligence, will be
done at my own expense.

I will not be under the influence of alcohol and /or drugs at the commencement of my tattoo appointment.

I acknowledge that I have truthfully represented to the independent contractors and representatives
Halfway House Tattoo that I am of the age of eighteen (18) or older and that the following information is
true and correct.

I give permission to the artists and studio to use pictures of my tattoo for portfolio displays as well as for
advertising purposes on the studio’s website and in all other marketing materials.

I agree to release and forever discharge and hold harmless Halfway House Tattoo and all its
independent contractors from any and all claims, damages, and legal actions arising from or connected in
any way with my tattoo and the procedures and conduct used to apply my tattoo.

Do any of these conditions apply to you? (Please provide details):
Blood/Bleeding Disorder
Diabetes
Epilepsy
Pregnant or Breastfeeding
Keloid Scars
Hepatitis
Communicable Disease (i.e HIV/AIDS)
Immunocompromised

Details:

Are you are taking any of the following medications? (Please provide details):
Blood Thinners (i.e Aspirin, Anti-Inflammatories)
Roaccutane
Antibiotics

Details:

All of the conditions/medications listed above have additional associated risks with being tattooed.
Please discuss with your Artist if there are any additional precautions you may need to take prior
(minimum of 21 days) to your appointment. If you do not discuss these with your Artist before hand
there is the possibility your appointment may be cancelled and your deposit forfeited.

What tattoo are you getting?

Approximate cost for this tattoo session.

Payment method

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.

Name:*

Address:*

Postcode:*

Date of birth:*

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

Age:

Phone #:*

Email:*

Signature:*

Sign 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.

Legal Name:*

Relationship:*

Signature:*

Sign or type signature:

Photo Identification *

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