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777 South 3rd St.
Jacksonville Beach, FL 32250
904-241-4231
carribbean-connection.com

September 20, 2018

TATTOO CONSENT FORM

In accordance with Florida state law, any individual receiving a tattoo MUST present valid government-issued ID.

For minors receiving a tattoo:

  • The minor must be at least 16 years of age andaccompanied by his or her parent or legal guardian.
  • Both the minor child and his or her parent or legal guardian must submit proof of his or her identity by producing a government-issued photo identification.
  • The parent or legal guardian must submitproof that he or she is the parent or legal guardian of the minor child.
  • The parent or legal guardian must submit his or her written notarized consent in the format prescribed by the department of health (Please ask front desk if you do not have a notarized consent form.)

 

Please respect our studio & artists:

  1. Please check-in at the front desk before proceeding into the tattoo area.
  2. No food or drinks are allowed in the tattoo area.
  3. No animals are allowed in the tattoo establishment, unless it is a service animal with proper documentation.
  4. Any person under the age of 18 who is not receiving a tattoo is not allowed in the tattoo area. Your children are not an exception to this rule.
  5. We understand you may want to bring a friend with you. We allow ONE friend to join you for your tattoo. Please do not bring your entire entourage.
  6. Do not touch fresh tattoos, or remove bandages in the tattoo studio; our artist will assist you if needed.

Professional Guarantee:

I understand Carribbean Connection's tattoo artists provide lifetime guarantees on their tattoo work whenand only whentheir professional advice and aftercare is followed. If I decide to not follow their professional and experienced advice, I understand they cannot guarantee their tattoo work. I understand some tattoos may require a touch-up after the tattoo is healed, and that the original tattoo artist, who did the initial tattoo at Carribbean Connection, will provide a touch-up at no extra cost, provided the touch-up is done within 30 to 60 days of the original tattoo session, and the touch-up is not needed due to lack of proper aftercare.

I Agree

I understand that Carribbean Connection's tattoo artistscan notguarantee tattoo work on the following areas of the body: fingers, hands/palms, behind the ear/neck, feet/toes, heel/ankle, elbows, knees, and ears. If I am concerned about getting a certain area tattooed, I will ask my tattoo artist first.

I Agree

I understand that Carribbean Connection's tattoo artists can not guarantee their tattoo work if during the tattoo session I experience excessive bleeding and/or swelling, or if I am unable to remain still during the tattoo - which may result in my tattoo artist ending my tattoo session early. Should this occur, I understand that my tattoo artist can not guarantee their work and I most likely will need a second session of a touch-up or to finish the tattoo, which will be billed at their hourly rate.

I Agree

Waiver and Liability Release:

This is to certify that I, the undersigned, have represented the correct information as noted.

I fully understand that I must be 18 years of age or older, or I must have a signed and notarized parental/legal guardian permission form to obtain a tattoo.

I Agree

I hereby state that there is no known medical history to indicate that I am a hemophiliac (bleeder), or carry any blood born diseases such as H.I.V., Hepatitis, etc.

I Agree

I am not pregnant.

I Agree

I do not have a heart condition or epilepsy.

I Agree

I am not under the influence of drugs or alcohol.

I Agree

I accept full responsibility for any consequences that may arise from my decision to get a tattoo.

I Agree

I will not file any lawsuit against Carribbean Connection, any employees of Carribbean Connection or any other company associated with Carribbean Connection.

I Agree

I understand that my tattoo is applied under strict hygienic conditions.

I Agree

I have received a copy of aftercare instructions, which I have read and fully understand and hereby assume full responsibility for aftercare and cleanliness of my tattoo.

I Agree

The tattoo inks at Carribbean Connection are safe and non-toxic. These inks have been used in the tattoo industry for years without any serious side effects. However, if you are allergy sensitive or have sensitive skin, there is a possibility of an allergic reaction to some pigments. If these conditions apply to you, please inform the tattoo artist prior to getting tattooed.

September 20, 2018

Please select who will be getting tattooed...
AdultMinor
Continue
First Client's Name

First Name*

Last Name*

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

Email*
Check to receive exclusive e-mail updates about upcoming promotions and new product info.
A signed copy of this waiver will be sent to the email address you provide.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Parent or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*
Client Information
Please select: *
I am an adult (18 years of age, or older)
I am a minor (17 years of age, or younger)

For the following question, please select "Beaches Baptist" if you do not have a personal physician you'd like to list.

Personal Physician: *
Beaches Baptist / 1350 13th Avenue S., Jacksonville Beach, FL 32250 / 904-627-2900
Other

If Other Personal Physician (Name/Address/Phone Number):

For the following fields, if none apply, please write in "N/A" or "None"


Allergies *

Bleeding Disorders *

Medical Conditions/Diseases *

Medications *

Date of Tattoo Procedure (Today's Date): *
Tattoo Information

Tattoo Design *

Location of Tattoo on Body *
Tattoo Artist:*
Nolan Duran
Derek Farrow
Guest Artist

If Guest Artist, please type name:
Other Information
How did you hear about us? *
Walk-in
Return Customer
Facebook
Instagram
Other

If Other, please explain:
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.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

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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