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Please sign this consent form/ protocol before your appointment.


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Lilith Tattoo Consent Form

Please read and initial the following statements:

I acknowledge by signing this agreement that I have been given the full opportunity to ask any and all questions which I might have about the obtaining of a tattoo and that all of my questions have been answered to my full satisfaction. I specifically acknowledge I have been advised of the facts and matters set forth below and I agree as follows:

  • If I have diabetes, epilepsy, hepatitis, hemophilia, HIV-AIDS, or any other communicable disease, heart condition or take medicine which thins the blood I may choose to advise my tattooer.
    I Agree
  • I am not pregnant or nursing.
    I Agree
  • I am not under the influence of alcohol or drugs.
    I Agree
  • I do not have medical conditions, skin conditions, or allergies (such as not limited to nuts, chemicals, oils, food, metals, latex, adhesives, and plastics). If I do, I have informed the artist of my conditions and allergies.
    I Agree
  • I acknowledge it is not reasonably possible for the artists of Lilith Tattoo to determine whether I might have an allergic reaction to the pigments or processes used in my tattoo,   and I agree to accept the risk that such a reaction is possible.
    I Agree
  • I acknowledge that infection is always possible as a result of the obtaining of a tattoo, particularly in the event that I do not take proper care of my tattoo. I agree to follow the aftercare as advised by my artist.
    I Agree
  • I agree that any touch up work needed, as a result of my own negligence, will be done at my own expense.
    I Agree
  • I realize that variations in colour and design may exist between any tattoo as selected by me and as ultimately applied to my body.
    I Agree
  • I understand that if I have any skin treatments, laser hair removal, plastic surgery or other skin altering procedures, drastic weight fluctuation, it may result in adverse changes to my tattoo.
    I Agree
  • I acknowledge that a tattoo is permanent change to my appearance and that no representations have been made to me as to the ability to later change or remove my tattoo.
    I Agree
  • To my knowledge, I do not have a physical, mental, or medical impairment or disability which might affect my well being as a direct or indirect result of my decision to have a tattoo.
    I Agree
  • I acknowledge I am over the age of eighteen and that I have truthfully represented to my tattooer that the obtaining of a tattoo is by my choice alone.
    I Agree
  • I consent to the application of the tattoo and to any actions or conduct of the representatives and artists at Lilith Tattoo reasonably necessary to perform the tattoo procedure.
    I Agree
  • I agree to have my tattoo photographed today. This may be for use in portfolios, advertising, and/ or social media by the artist or the studio. If I do not consent to this, I have informed my tattooer prior to the tattoo procedure.
    I Agree
  • I am required to show my state issued ID to my artist. Failure to do so at appointment may result in a reschedule or cancellation.
    I Agree

By signing this, I am consenting to a tattoo procedure provided by my artist at Lilith Tattoo on my appointment date.

 

Lilith Tattoo Covid Protocol

Please read carefully and sign. All clients getting tattooed by artists at Lilith must comply to this protocol, if you are unable to do so, we are not able to tattoo you at this time. All of our artists reserve the rights to cancel/ reschedule an appointment at anytime they feel that our health and yours may be at risk.

  • All clients of Lilith Tattoo are required to be masked in the studio space (aside from taking water breaks, etc. in designated area).
  • If you are having the following symptoms please inform your artist, we will not be able to tattoo you at this time: Cough, fever, shortness of breath.
  • Please eat and drink before your appointment. Please bring your own water/ beverage. We have candies for emergencies but if you need to take a while to eat in between your tattoo session, you will be asked to do so outside the premise.
  • Please maintain your hygiene before coming in (shower) for your appointment as courtesy for your artist. Please don’t come after a sweaty run, workout, etc. This minimizes the exchange of contact to fluids in the studio. If you are coming after work, please take sometime to clean up and change your clothes.
  • No guests are allowed unless you have informed your artist (with exception of accessibility) / service animals are not allowed in the tattoo area.
  • Please do not touch your artist without their consent.
  • You are required to alert us if you test positive for Covid-19 within 5 days of your appointment.

June 20, 2024


First Client's Name

First Name*

Last Name*

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

Client's pronouns

Client's accessibility needs

Who is your artist for this session? *

Brief description of your tattoo/ placement on body

Date of your tattoo session *
First Client's Signature*
Second Client's Name

First Name*

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

Client's pronouns

Client's accessibility needs

Who is your artist for this session? *

Brief description of your tattoo/ placement on body

Date of your tattoo session *
Third Client's Name

First Name*

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

Client's pronouns

Client's accessibility needs

Who is your artist for this session? *

Brief description of your tattoo/ placement on body

Date of your tattoo session *
Fourth Client's Name

First Name*

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

Client's pronouns

Client's accessibility needs

Who is your artist for this session? *

Brief description of your tattoo/ placement on body

Date of your tattoo session *
Fifth Client's Name

First Name*

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

Client's pronouns

Client's accessibility needs

Who is your artist for this session? *

Brief description of your tattoo/ placement on body

Date of your tattoo session *
Sixth Client's Name

First Name*

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

Client's pronouns

Client's accessibility needs

Who is your artist for this session? *

Brief description of your tattoo/ placement on body

Date of your tattoo session *
Seventh Client's Name

First Name*

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

Client's pronouns

Client's accessibility needs

Who is your artist for this session? *

Brief description of your tattoo/ placement on body

Date of your tattoo session *
Eighth Client's Name

First Name*

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

Client's pronouns

Client's accessibility needs

Who is your artist for this session? *

Brief description of your tattoo/ placement on body

Date of your tattoo session *
Ninth Client's Name

First Name*

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

Client's pronouns

Client's accessibility needs

Who is your artist for this session? *

Brief description of your tattoo/ placement on body

Date of your tattoo session *
Tenth Client's Name

First Name*

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

Client's pronouns

Client's accessibility needs

Who is your artist for this session? *

Brief description of your tattoo/ placement on body

Date of your tattoo session *
Parent or Guardian's Email Address

Email*

Confirm Email*
Emergency Contact

First Name*

Last Name*

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

Driver's License / ID Card Number*

Issuing State*
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 pronouns

Client's accessibility needs

Who is your artist for this session? *

Brief description of your tattoo/ placement on body

Date of your tattoo session *
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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