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I Understand that

All questions on this form are mandatory due to the law passed in 2012

AB 300- The Safe Body Art Act- California Health And Safety Code Section 119307

 

 

Being of sound mind and body do I release any and all persons representing Soul Imagez Tattoo from all responsibility? By initialing I agree to all responsibility and consequences that may come from my decision to have any tattoo related work done by Soul Imagez Tattoo. By initialing I understand that this waiver also pertains to and is designed to protect any and all establishments and persons where Soul Imagez Tattoo conducts business. By intialing I agree to these terms stated in this form.


I do not have HIV, hepatitis, herpes infection at the proposed procedure site, diabetes, allergic reactions to latex or antibiotics, hemophilia or other bleeding disorder, or cardiac valve disease


I am 18 years of age or older.


I am not under the influence of any prescribed or illegal drug, history of medication use or am not currently using medication, including being prescribed antibiotics prior to dental or surgical procedures or Other risk factors for bloodborne pathogen exposure.


I am not pregnant or will not be nursing a child.


 

Do you understand that all deposits given are non refundable and are only valid for 90 days from from the date on your receipt.

A 24 hour notice must be given to to your artist by phone or in person in order for the deposit to be put towards a rescheduled appointment. If no 24 hour notice is given your deposit will be lost and not applied to your tattoo. By initialing you understand our deposit policy.


 

I understand that all inks, dyes and pigment have not been approved by the FDA and health consequenses of using products are unknown.


During this procedure you will be tattooed with ink that is permanent and cannot be easily removed. During the tattoo process, you will feel pain caused by a tattoo needle. This needle will make an art pattern that is permanent. During the process we will create art on your skin. After the tattoo is done we will apply a bandage to the skin. Follow the aftercare instructions given to you. If you did not get an aftercare instructions, it is important that you ask for one. By initialing below, you understand the tattoo process and the permanent nature of getting a tatt


 

 




First Client's Name

First Name*

Last Name*

Phone*
First Client's Date of Birth*
First Client's Signature*
Second Client's Name

First Name*

Last Name*
Second Client's Date of Birth*
Third Client's Name

First Name*

Last Name*
Third Client's Date of Birth*
Fourth Client's Name

First Name*

Last Name*
Fourth Client's Date of Birth*
Fifth Client's Name

First Name*

Last Name*
Fifth Client's Date of Birth*
Sixth Client's Name

First Name*

Last Name*
Sixth Client's Date of Birth*
Seventh Client's Name

First Name*

Last Name*
Seventh Client's Date of Birth*
Eighth Client's Name

First Name*

Last Name*
Eighth Client's Date of Birth*
Ninth Client's Name

First Name*

Last Name*
Ninth Client's Date of Birth*
Tenth Client's Name

First Name*

Last Name*
Tenth Client's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Which City Are You Visiting From

City Name *
Who is your tattoo artist?
Who is your tattoo artist?*
What is the price you were quoted?
How did you first hear about Soul Imagez Tattoo?

Please feel free to contact the owner Joshua at anytime if you have any concerns with your tattoo. Joshua will always do his best to help every one that comes to Soul Imagez Tattoo.

Please Choose Service.

Soul Imagez Tattoo 

2092 Concourse Dr Ste 37 San Jose, Ca 95131

408-856-5221

7127 Dublin Blvd Dublin, Ca 94568

925-294-0307

soulimagez.com 


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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 Signature*
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.


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