CONSENT OF APPLICATION OF TATTOO and RELEASE AND WAIVER OF ALL CLAIMS

CONSENT OF APPLICATION OF TATTOO and RELEASE AND WAIVER OF ALL CLAIMS

PLEASE CHECK ALL THAT APPLY:

I acknowledge that I have truthfully represented to the associates, agents, and representatives of Black Rabbit Tattoo that I am at least eighteen (18) years of age.

I Agree

I acknowledge that tattooing is an invasive procedure in which the skin is penetrated by a foreign object.

I Agree

I acknowledge that if proper sterilization and antiseptic procedures are not followed by tattoo artists there is a risk of transmission of blood-borne pathogens and other infections, including, but not limited to, human immunodeficiency viruses (HIV) and hepatitis B or C viruses.

I Agree

I acknowledge that tattooing may cause allergic reactions in persons sensitive to dyes.

I Agree

I acknowledge that tattooing involves discomfort or pain in which appropriate anesthesia cannot be legally made available by the person performing the tattoo, unless such person holds the appropriate license from a Virginia health regulatory board.

I Agree

I acknowledge that I am not pregnant.

I Agree

I acknowledge that I am free of communicable disease.

I Agree

I acknowledge that tattooing may increase sensitivity to keloid formation.

I Agree

I acknowledge that I have read the aftercare instructions provided by the shop or artist. These can be found in the FAQ section of our web site.

I Agree

I acknowledge that variations of color and design may exist between any tattoos, as selected by me, and as ultimately applied to my body.

I Agree

I acknowledge that tattooing is a permanent change to my appearance and that no representations have been made to me as to the ability to later change, alter or remove my tattooo.

I Agree

I acknowledge that the obtaining of my tattoo is by my choice alone, and I consent to the application of the tattoo and to any actions or conduct of the associates, agents or representatives of Black Rabbit Tattoo reasonably necessary to perform the tattoo procedure.

I Agree

I agree to release and forever discharge and hold harmless Black Rabbit Tattoo and its associates, agents, officers, and shareholders from any and all claims, damages, or legal actions arising from, or connected in any way with, my tattoo or the procedures and conduct used to apply my tattoo.

I Agree

By signing below I acknowledge that I have read the above information and that I have been given the full opportunity to ask any and all questions I might have about obtaining a tattoo from Black Rabbit Tattoo. I acknowledge that all of my questions have been answered to my full and total satisfaction.

Date: March 13, 2025

*ATTENTION* Please enter your PREFERRED name below!

You'll enter the name that shows up on your ID later!

First Client Name

First Name*

Last Name*

Phone*

First Client Date of Birth*

First Client Information

Client's Age

Type of ID Provided

Pronouns

Please List Any Known Allergies:

Any Accessibility Concerns? (weight capacities, wheelchair access, injuries, etc.)

Do you consent to you and/or your tattoo being photographed and/or filmed?*

Yes

Do you acknowledge that security cameras are recording at all times?*

Yes

Short Description of Tattoo

Tattoo Location on the Body

First Client Signature*

Type Signature

Draw Signature

Click to Sign

Second Client Name

First Name*

Last Name*

Second Client Date of Birth*

Second Client Information

Client's Age

Type of ID Provided

Pronouns

Please List Any Known Allergies:

Any Accessibility Concerns? (weight capacities, wheelchair access, injuries, etc.)

Do you consent to you and/or your tattoo being photographed and/or filmed?*

Yes

Do you acknowledge that security cameras are recording at all times?*

Yes

Short Description of Tattoo

Tattoo Location on the Body

Third Client Name

First Name*

Last Name*

Third Client Date of Birth*

Third Client Information

Client's Age

Type of ID Provided

Pronouns

Please List Any Known Allergies:

Any Accessibility Concerns? (weight capacities, wheelchair access, injuries, etc.)

Do you consent to you and/or your tattoo being photographed and/or filmed?*

Yes

Do you acknowledge that security cameras are recording at all times?*

Yes

Short Description of Tattoo

Tattoo Location on the Body

Fourth Client Name

First Name*

Last Name*

Fourth Client Date of Birth*

Fourth Client Information

Client's Age

Type of ID Provided

Pronouns

Please List Any Known Allergies:

Any Accessibility Concerns? (weight capacities, wheelchair access, injuries, etc.)

Do you consent to you and/or your tattoo being photographed and/or filmed?*

Yes

Do you acknowledge that security cameras are recording at all times?*

Yes

Short Description of Tattoo

Tattoo Location on the Body

Fifth Client Name

First Name*

Last Name*

Fifth Client Date of Birth*

Fifth Client Information

Client's Age

Type of ID Provided

Pronouns

Please List Any Known Allergies:

Any Accessibility Concerns? (weight capacities, wheelchair access, injuries, etc.)

Do you consent to you and/or your tattoo being photographed and/or filmed?*

Yes

Do you acknowledge that security cameras are recording at all times?*

Yes

Short Description of Tattoo

Tattoo Location on the Body

Sixth Client Name

First Name*

Last Name*

Sixth Client Date of Birth*

Sixth Client Information

Client's Age

Type of ID Provided

Pronouns

Please List Any Known Allergies:

Any Accessibility Concerns? (weight capacities, wheelchair access, injuries, etc.)

Do you consent to you and/or your tattoo being photographed and/or filmed?*

Yes

Do you acknowledge that security cameras are recording at all times?*

Yes

Short Description of Tattoo

Tattoo Location on the Body

Seventh Client Name

First Name*

Last Name*

Seventh Client Date of Birth*

Seventh Client Information

Client's Age

Type of ID Provided

Pronouns

Please List Any Known Allergies:

Any Accessibility Concerns? (weight capacities, wheelchair access, injuries, etc.)

Do you consent to you and/or your tattoo being photographed and/or filmed?*

Yes

Do you acknowledge that security cameras are recording at all times?*

Yes

Short Description of Tattoo

Tattoo Location on the Body

Eighth Client Name

First Name*

Last Name*

Eighth Client Date of Birth*

Eighth Client Information

Client's Age

Type of ID Provided

Pronouns

Please List Any Known Allergies:

Any Accessibility Concerns? (weight capacities, wheelchair access, injuries, etc.)

Do you consent to you and/or your tattoo being photographed and/or filmed?*

Yes

Do you acknowledge that security cameras are recording at all times?*

Yes

Short Description of Tattoo

Tattoo Location on the Body

Ninth Client Name

First Name*

Last Name*

Ninth Client Date of Birth*

Ninth Client Information

Client's Age

Type of ID Provided

Pronouns

Please List Any Known Allergies:

Any Accessibility Concerns? (weight capacities, wheelchair access, injuries, etc.)

Do you consent to you and/or your tattoo being photographed and/or filmed?*

Yes

Do you acknowledge that security cameras are recording at all times?*

Yes

Short Description of Tattoo

Tattoo Location on the Body

Tenth Client Name

First Name*

Last Name*

Tenth Client Date of Birth*

Tenth Client Information

Client's Age

Type of ID Provided

Pronouns

Please List Any Known Allergies:

Any Accessibility Concerns? (weight capacities, wheelchair access, injuries, etc.)

Do you consent to you and/or your tattoo being photographed and/or filmed?*

Yes

Do you acknowledge that security cameras are recording at all times?*

Yes

Short Description of Tattoo

Tattoo Location on the Body

Legal Name

Enter your legal name

Please upload a photo of your ID (front only)

Click to customize text box label

Valid file types: JPG, GIF, PNG, and PDF

Client Address

Address Line 1:*

Street address, P.O. box, company name, c/o

Address Line 2:

Apartment, suite, unit, building, floor, etc.

Country:*

City:*

State/Province:*

Zip/Postal:*

Parent or Guardian's Email Address

Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.

APPRENTICE AND FIRST-YEAR TATTOOER ACKNOWLEDGEMENT

If you are getting tattooed by an Apprentice or First-Year Tattooer, please acknowledge that you have reviewed examples of their work, and consent to being tattooed by someone who is early in their professional career by selecting “yes”.*

Yes

Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.

By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.

Parent or Guardian's Name

First Name*

Last Name*

Phone*

Parent or Guardian's Date of Birth*

Parent or Guardian's Information

Client's Age

Type of ID Provided

Pronouns

Please List Any Known Allergies:

Any Accessibility Concerns? (weight capacities, wheelchair access, injuries, etc.)

Do you consent to you and/or your tattoo being photographed and/or filmed?*

Yes

Do you acknowledge that security cameras are recording at all times?*

Yes

Short Description of Tattoo

Tattoo Location on the Body

Parent or Guardian's Signature*

Type Signature

Draw Signature

Click to Sign

Electronic Signature Consent*

By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.