Date of the Tattoo Appointment *

MM

DD

YYYY

Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

I am over the age of 18 *

Yes

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Please indicate if you have experienced any of the following Covid-19 symptoms in the last 14 days *

Shortness Of Breath

Fever

Chills

Cough

Sore Throat

I’ve experienced NO symptoms related to Covid-19

Have you been around anyone with these symptoms in the last 14 days? *

Yes

No

I have eaten before coming in today *

Yes

No

I am not under the influence of drugs or alcohol *

I agree

I understand that my tattoo is non-refundable *

I understand

I confirm that I'm doing this of my own free will. I know I can stop the procedure at any time, including right now. *

I agree

I understand that a tattoo is a permanent change to my appearance and can only be removed by laser or surgical means *

I agree

I am fully aware of the inherent risks that may be associated with getting a tattoo (i.e. infections, scarring, allergic reactions, etc.) and still wish to proceed with the tattooing procedure and application. *

I agree

I understand that once I leave the studio it is my responsibility to follow proper aftercare instructions. I acknowledge that not doing so can increase the risk of infection and may also require my tattoo to need touch ups. *

I agree

I understand that touch ups can range from $20.00 to the full rate, especially if I do not take care of my tattoo. This rate is entirely subject to the tattooist’s discretion *

I agree

I understand that any form of abuse or harassment will not be tolerated and I will be asked to leave the shop, forfeiting my deposit *

I agree

I understand that my tattooist may take photos of my tattoo to post to Instagram and build their portfolio. I give my consent to do so *

I agree

I disagree

I agree to release the tattooist, the shop, and it's owners, heirs, partners, agents, employees, contractors and/or affiliates of all claims and liabilities against them *

I agree

I acknowledge that I have been given adequate opportunity to read and understand this document. I understand that by clicking ‘submit’ I am signing a legal contract *

I agree