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Let us do this part
Today's Date:
Tue Mar 17 2026 07:26
Practitioner:
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-- Select --
Sam
Signature:
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Please fill in this form then hand back to the artist for them to view and sign before submitting.
Thank you !
Please read and answer
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I have been fully informed of the inherent risks associated with getting a tattoo. difficulties Therefore, in I fully understand that these risks, known and unknown, can lead to injury including but not limited to: infection, scarring, detection of melanoma and allergic reactions to tattoo pigment, latex gloves and/or soap. Having been informed of the potential risks associated with getting a tattoo I wish to proceed with the tattoo procedure and application and freely accept and expressly assume any and all risks that may arise from tattooing.
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I WAIVE AND RELEASE to the fullest extent permitted by law any person of the Tattoo Studio from all liability whatsoever, including but not limited to, 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 the procedure and application of my tattoo, whether caused by the negligence or fault of either the Tattoo Studio, or otherwise.
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The Tattoo Studio has given me the full opportunity to ask any question about the procedure and application of my tattoo and all of my questions, if any, have been answered to my total satisfaction.
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The Tattoo Studio has given me instructions on the care of my tattoo while it's healing. I understand and will follow them. I acknowledge that it is possible that the tattoo can become infected, particularly if 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 not under the influence of alcohol or drugs, and I am voluntarily submitting to be tattooed by the Tattoo Studio without duress or coercion
Y
N
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I do not suffer from diabetes, epilepsy, hemophilia, heart condition(s), nor do I take blood thinning medication. I do not have any other medical or skin condition that may interfere with the procedure, application or healing of the tattoo. I am not the recipient of an organ or bone marrow transplant or, if I am, I have taken the prescribed preventative regimen of antibiotics that is required by my doctor in advance of any invasive procedure such as tattooing or piercing. I am not pregnant or nursing. I do not have a mental impairment that may affect my judgement in getting the tattoo. Please add any medical conditions and/or medication including but not limited to the following
Diabetes
Any allergies
Hepatitis
Heart conditions
Skin conditions
Epilepsy
Haemophilia
Blood thinning medication
Organ or bone marrow transplant
Pregnant or breast feeding
Please write ANY medications and/or allergies you have
Details:
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The Tattoo Studio not responsible for the meaning or spelling of the symbol or text that I have provide to them or chosen during the consultation
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Variations in color and design may exist between the tattoo art I have selected and the actual tattoo when it is applied to my body. I also understand that over time, the colors and the clarity of my tattoo will fade due to unprotected exposure to the sun and the naturally occurring dispersion of pigment under the skin
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 to its exact appearance before being tattooed.
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I release the right to any photographs taken of me and the tattoo and give consent in advance to their reproduction in print or electronic form. For assurance, if you do not initial this provision, please inform the Tattoo Studio NOT to take any pictures of you and your completed tattoo.
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I agree that the Tattoo Studio has a NO REFUND policy on tattoos or deposits. I will not ask for a refund for any reason whatsoever.
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I agree to reimburse the Tattoo Studio for any attorneys' fees and costs incurred in any legal action I bring against the Tattoo Studio and in which either the Artist of the Tattoo Studio is the prevailing 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
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I acknowledge that I have been given adequate opportunity to read and understand this document that it was not presented to me at the last minute and grasp that I am signing a legal contract waiving certain rights to recover damages against the Tattoo Studio.
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I hereby declare that I am of legal age (and have provided valid proof of age and identification) and am competent to sign this agreement
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I HAVE READ THE AGREEMENT, I UNDERSTAND IT, AND I AGREE TO ALL TERMS ABOVE.
Thank you for taking the time to fill in your consent form.
Please save the below link for all other information relating to your tattoo, this includes after care
https://dopeydodo.bigcartel.com/
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:
-select-
He/Him
She/Her
They/Them
He/Them
She/Them
He/She
He/She/They
Other
Chosen name:
Address:
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Postcode:
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Date of birth:
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You must be 18 or older
Age:
Phone #:
*
Email:
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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:
*
Signature:
*
Sign or type 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
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