Name *

First Name

Last Name

In the next section, read and CHECK IN EACH BOX to indicate ​you understand and agree to the below provision.

I acknowledge by signing this agreement that I have been given the full opportunity to ask any and all questions which I might have about the obtaining of a tattoo and that all of my questions have been answered to my full satisfaction. 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 fully informed of these risks I still wish to proceed with the tattoo application and I freely accept and expressly assume any and all risks that may arise from tattooing. *

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

If I have any condition that might affect the healing of this tattoo, I will advise my tattooer. If I have diabetes, epilepsy, hepatitis, hemophilia, HIV-AIDS, or any other communicable disease, heart condition or take medicine which thins the blood, I will advise the Artist. I am not the recipient of an organ or bone marrow transplant, or, if I am, I have taken the prescribed preventative regiment of antibiotics that is required by my doctor in advance of any invasive procedure such as tattooing. *

I am not pregnant or nursing. I am not under the influence of alcohol or drugs and I am voluntarily submitting to be tattooed by the Artist without duress or coercion. *

I do not have medical or skin conditions such as but not limited to: acne, scarring (Keloid) eczema, psoriasis, freckles, moles or sunburn in the area to be tattooed that may interfere with said tattoo. If I have any type of infection or rash anywhere on my body, I will advise my tattooer. *

I acknowledge it is not reasonably possible for the representatives and employees of this tattoo shop to determine whether I might have an allergic reaction to the pigments or processes 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 the obtaining of a tattoo, particularly in the event that I do not take proper care of my tattoo. I have received aftercare instructions and I agree to follow them while my tattoo is healing. I agree that any touch-up work needed, due to my own negligence, will be done at my own expense. *

I realize that variations in color and design may exist between any tattoo as selected by me and as ultimately applied to my body. I understand that if my skin color is dark, the colors will not appear as bright as they do on light skin. I also understand that over time, the colors and clarity of my tattoo will fade due to unprotected exposure to the sun and naturally occurring dispersion of pigment under the skin. *

I understand that if I have any skin treatments, laser hair removal, plastic surgery or other skin altering procedures, it may result in adverse changes to my tattoo. *

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 acknowledge that a tattoo is a permanent change to my appearance and that no representations have been made to me as to the ability to later change or remove my tattoo. To my knowledge, I do not have a physical, mental or medical impairment or disability which might affect my well being as a direct or indirect result of my decision to have a tattoo. *

I release all rights to any photographs taken of me and the tattoo and give consent in advance to their reproduction in print and/or electronic form. (If you do not initial this provision, please advise and remind your Artist and the Tattoo Studio NOT to take any pictures of you and your completed tattoo.) *

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 I understand that I am signing a legal contract waiving certain rights to recover against the Artist and the Tattoo Studio. *

I acknowledge I am over the age of eighteen and that I have truthfully represented to my tattooer, provided valid proof of age and that the obtaining of a tattoo is by my choice alone. I consent to the application of the tattoo and to any actions or conduct of the representatives and employees of the tattoo shop reasonably necessary to perform the tattoo procedure. *

Date of Birth (MM/DD/YY) *

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I HAVE READ THE FULL AGREEMENT ABOVE, I UNDERSTAND IT, I AGREE TO BE BOUND BY IT BY E-SIGNING IN THE CHECK BOX. *

Today's date (MM/DD/YYYY) * *

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