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SUPERCHANGO TATTOO STUDIO

PLEASE READ THE FOLLOWING NOTICE:

You are hereby notified of the possible risks and dangers associated with the application of each tattoo. These risks and dangers include, but are not limited to, at least the following:

1. The possibility of pain or discomfort

2. The permanence of the markings

3. The risk of infection

4. The possibility of allergic reaction to the pigments or other materials used. (Please notify artist if you are allergic to latex or any other materials)


I understand that I will receive a copy of the applicable written care instructions at the completion of each tattoo session. I hereby release Superchango and all of it’s associates, artists, and the owners from any and all claims of liability. Being of sound mind, knowing the risks associated with getting a tattoo, I agree to all of the above. I state that the identification I have given it’s mine and that I am at least 18 years of age. I know that it is against the law and I can be prosecuted for false ID.

First Client Name

First Name*

Last Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

Email
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*
Click to upload ID
  
Valid file types: JPG, GIF, PNG, and PDF
Client 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(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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