Loading...

Forbidden Anchor Tattoo Consent & Release Form
(Tattoo)

  • Tattooing involves the placement of pigment into the epidermis of the skin, the layer of dermal tissue underlying the epidermis. After initial injection, the pigment is dispersed throughout a homogenized damaged layer down through the epidermis and upper dermis, in both of which the presence of foreign material activates the phagocytes (macrophages) of the immune system to engulf the pigment particles. As healing proceeds, the damaged epidermis flakes away (eliminating surface pigment) while deeper in the skin, granulation tissue forms. This is later converted to connective tissue by collagen growth. This mends the upper dermis, where pigment remains trapped with fibroblasts, ultimately concentrating in a layer just below the dermis/epidermis boundary. It's presence there is stable, but in the long term (decades) the pigment tends to migrate deeper into the dermis, accounting for the degraded detail of old tattoos.

I Agree
 

  • I acknowledge I am over the age of 18 and that I have truthfully represented to my tattoo artist that the obtaining of this tattoo is by my choice alone. I consent to the application of the tattoo and any actions necessary to perform the procedure. 

I Agree

  • I am not pregnant or nursing. I do not have epilepsy. I do not suffer from any heart conditions, such cardiac valve disease, or take medication which thins the blood. I have informed my tattoo artist of any condition, such as diabetes, that might hamper healing of the tattoo. I do not have hepatitis, H.I.V, hemophilia, or other bleeding disorders. I have no history of herpes infection at proposed procedure site or any other communicable diseases. I am not currently using medication, including being prescribed antibiotics prior to dental or surgical procedures. 

I Agree

  • I am not under the influence of drugs or alcohol. To the best of my knowledge, I do not have any physical, mental, or medical impairments / disability that might affect my well being as a direct or indirect result of my decision to have any tattoo related work done at this time. 

I Agree

  • 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 the tattoo process. 

I Agree

  • I acknowledge it is not reasonably possible for the representatives and employees of Forbidden Anchor Tattoo to determine whether I might have an allergic reaction to latex, antibiotics, or the pigments / processes used in my tattoo, and I agree to accept the risk that such a reaction is possible. 

I Agree

  • I agree for myself, my heirs, assigns and legal representatives, to hold Forbidden Anchor Tattoo harmless from all damages, actions, causes of action, claim judgements, costs of litigations, attorney's fees, and all other costs and expenses, which might arise from my decision to have any tattoo related work done by Forbidden Anchor Tattoo. 

I Agree

  • I understand I will be tattooed using sterilized instruments and appropriate techniques. I understand that this type of tattoo usually takes up to two (2) weeks or longer to heal. I acknowledge that infection is always possible as a result of obtaining 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 Agree

  • Tattoo inks, dyes, and pigments are not approved by the Food and Drug Administration (FDA). 

I Agree

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

I Agree

  • 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 / cover / alter my tattoo. 

I Agree

  • I agree that these waivers also pertain to and are designed to protect any and all establishments where Forbidden Anchor Tattoo conducts business. 

I Agree

  • I release all rights to any photographs taken of me and the tattoo and give consent in advance to their reproduction in print or electronic form. 

I Agree

​I agree to all the aforementioned terms

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Gender/Preferred Gender Pronoun

Gender/PGP
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Gender/Preferred Gender Pronoun

Gender/PGP
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Gender/Preferred Gender Pronoun

Gender/PGP
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Gender/Preferred Gender Pronoun

Gender/PGP
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Gender/Preferred Gender Pronoun

Gender/PGP
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Gender/Preferred Gender Pronoun

Gender/PGP
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Gender/Preferred Gender Pronoun

Gender/PGP
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Gender/Preferred Gender Pronoun

Gender/PGP
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Gender/Preferred Gender Pronoun

Gender/PGP
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Gender/Preferred Gender Pronoun

Gender/PGP
Participant'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*

Confirm Email*
Check to stay in the loop with Forbidden Anchor Tattoo promotions and discounts!
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*
Tattoo Information
Artist Name*

Tattoo Design Description *

Location on Body *
How did you hear about us?*
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*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Gender/Preferred Gender Pronoun

Gender/PGP
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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver