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Please sign this consent form/ protocol before your appointment.

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

 

Lilith Tattoo Covid Protocol

Please read carefully and sign or inform your artist via email that you’ve read and consent to this protocol. 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 fully vaccinated with proof for your artist before appointment.  If you are opting out of vaccination, you are required to get tested within the week of getting tattooed. Covid testing is free in Seattle.
  • 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
  • If you been in close contact with anyone with these symptoms or anyone who has been diagnosed with COVID-19 in the past 14 days. Please inform your artist.
  • Wear a mask before you enter the studio. You will not be allowed to enter the studio without a mask. You will be masked for the whole time in the studio (aside from taking water breaks, etc. in designated area).
  • Your temperature will be taken when you arrive with a contactless thermometer. If your temperature is over 100.3F, you will be rescheduled.
  • Please wash your hands immediately upon entering the studio.
  • 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 (unless for accessibility) / service animals are allowed at this time in order to limit the total number of people in the studio
  • Do not touch your artist.
  • If you arrive early or there is an overlap between client sessions, we may ask you to wait outside or come back at another time just to minimize overlap of people.
  • You are required to alert us if you test positive for Covid-19 within 2 weeks of your appointment. All clients who entered the studio after the infected client and before deep cleaning will be notified

June 13, 2021

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 today?

Brief description of your tattoo/ placement on body
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 today?

Brief description of your tattoo/ placement on body
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 today?

Brief description of your tattoo/ placement on body
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 today?

Brief description of your tattoo/ placement on body
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 today?

Brief description of your tattoo/ placement on body
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 today?

Brief description of your tattoo/ placement on body
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 today?

Brief description of your tattoo/ placement on body
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 today?

Brief description of your tattoo/ placement on body
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 today?

Brief description of your tattoo/ placement on body
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 today?

Brief description of your tattoo/ placement on body
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*

Confirm Email*
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*
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 information

Client's pronouns

Client's accessibility needs

Who is your artist today?

Brief description of your tattoo/ placement on body
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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