Tattoo Consent and Waiver Form
Let us do this part
Today's Date:
Sat Jul 4 2026 09:25
Practitioner:*
Location of Tattoo on body (e.g right leg, left forearm, lower back):*
Date of tattoo appointment.:*
Alchemy Moon Tattoo Collective.
Consent/Waiver Form.
Please read and answer
Y
N
PLEASE SELECT YES TO ACKNOWLEDGE THIS INFORMATION!

Known potential risks associated with tattooing. Blood poisoning, localised infection, allergic reaction to pigment, localised swelling to area of the tattoo.

If fortunate to look under 25, ID will be requested. There is a section below for you to take a picture of your I.D.

Y
N
Have you ever been tattooed before?
Y
N
Are you pregnant or breastfeeding?
Y
N
Are you prone to fainting/blackouts?
Y
N
Do you have a heart condition, epilepsy or diabetes?

Details: 
Y
N
Are you a hemophiliac or on any medications that may cause bleeding or may hinder clotting? Are you taking any regular medication?
If yes, please explain.

Details: 
Y
N
Do you have any communicable diseases? (H.I.V, A.I.D.S, HEPATITIS)
Y
N
Do you have any allergies?
If yes, please explain.

Details: 
- I declare I give my full consent to the tattooing being carried out by the aforementioned artist.
- I understand that infection is always possible at the result of having a tattoo. I acknowledge I will receive aftercare instructions from my artist and I agree to care for my tattoo to the best of my ability. I also acknowledge that full aftercare instructions are located on the Alchemy Moon website.
- I understand touch ups are free of charge if brought to the attention of my artist within 2 months of my appointment and will be at the artists discretion.
- I acknowledge the tattoo is permanent.
- I understand the finished tattoo may vary somewhat in appearance, colour from the paper, drawing or photographic image which the tattoo design is based.
- I give consent for the image of my tattoo to be used on the website/social media pages of the studio.
- I am aware that any quotes are just that and the final price may vary from any given quotes.
- I confirm that the above information provided for me for this form is correct to the best of my knowledge, that I am not pregnant or breastfeeding, that I am over the age of consent for this procedure (18 years old) and that I am not currently under the influence of drugs or alcohol.
The purpose of this document is to protect both parties in the event of an incident claim. By signing this document, you agree for ALCHEMY MOON TATTOO COLLECTIVE to keep your details on file for up to 25 years, where they will be stored in a secure location away from the public. We do not use any of your information provided for unsolicited use. We do not credit/debit card details on our system. You have the right to request your information be removed from our records at any point but doing so will affect your legitimacy in the event of a claim.
Therefore, upon reading this document, I agree for the application of the tattoo. I agree to release ALCHEMY MOON TATTOO COLLECTIVE and it’s ARTISTS from which any and all claims, damages or legal actions arising from, or connected in anyway to my tattoo or the procedure and conduct used in the application of my tattoo.
Y
N
Eating before a tattoo appointment is most important to keep your energy levels up.
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:*
Pronouns:
Chosen name:
Address:*
Postcode:
Date of birth:*
 
You must be 18 or older
Age: 
Phone #:*
Email:*
Signature:*

Emergency Contact
If something happens, your emergency contact might need to explain your medical history, allergies, or medications.
Name:
Phone #:
Photo Identification
Please take photo(s) of your government issued photo IDs and related paperwork