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Release and Waiver:

I acknowledge by signing this waiver that I have been given the full opportunity to ask all questions, I might have about a Tattoo from my artist. All my questions have been answered to my full and total satisfaction. I specifically acknowledge that I have been advised of the facts and matters set forth below, and by my initials I agree as follows: 

I Agree

I acknowledge that it is not reasonably possible for my artist to determine whether I might have an allergic reaction to the dyes or saniderm. 

I Agree

I acknowledge that infection is always possible, particularly if I do not take proper care of my tattoo. 

I Agree

I acknowledge receipt of written or verbal instructions advising me of the proper care of my tattoo and recognize the absolute necessity of following these instructions. 

I Agree

I realize that variations in color and design may exist between any tattoo represented on paper selected by me as ultimately Applied to my body. 

I Agree

I am over the age of eighteen years and the identification that I am providing to prove this claim has been legitimately represented as my own. 

I Agree

I acknowledge that I am not under the influence of any drugs or alcohol or any other intoxicating substance at the time of the procedure. 

I Agree

I hereby give my artist permission to copyright and/or use and publish photographic portraits or pictures of me. In which I may be included in whole or in partial view. I waive any right I may have to inspect and/or approve the finished product of the photos that may be taken and posted for advertisement of the artists portfolio. 

I Agree

I agree to release and forever discharge and hold harmless my artist, any employees, and the studio. In which my tattoo/piercing is applied from all claims, damages, or legal actions arising from or connected in any way with my tattoo. 

I Agree

May 4, 2024

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

Your history:


Do you have any medical history we should be aware of?

Do you have any diseases we should be aware of?

Pronoun you would like to be referred to by;
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

Your history:


Do you have any medical history we should be aware of?

Do you have any diseases we should be aware of?

Pronoun you would like to be referred to by;
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

Your history:


Do you have any medical history we should be aware of?

Do you have any diseases we should be aware of?

Pronoun you would like to be referred to by;
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

Your history:


Do you have any medical history we should be aware of?

Do you have any diseases we should be aware of?

Pronoun you would like to be referred to by;
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

Your history:


Do you have any medical history we should be aware of?

Do you have any diseases we should be aware of?

Pronoun you would like to be referred to by;
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

Your history:


Do you have any medical history we should be aware of?

Do you have any diseases we should be aware of?

Pronoun you would like to be referred to by;
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

Your history:


Do you have any medical history we should be aware of?

Do you have any diseases we should be aware of?

Pronoun you would like to be referred to by;
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

Your history:


Do you have any medical history we should be aware of?

Do you have any diseases we should be aware of?

Pronoun you would like to be referred to by;
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

Your history:


Do you have any medical history we should be aware of?

Do you have any diseases we should be aware of?

Pronoun you would like to be referred to by;
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

Your history:


Do you have any medical history we should be aware of?

Do you have any diseases we should be aware of?

Pronoun you would like to be referred to by;
Parent or Guardian's Email Address

Email*

Confirm Email*
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Additional Information
  
Upload a State ID / Driver License *
Valid file types: JPG, GIF, PNG, and PDF
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*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Your history:


Do you have any medical history we should be aware of?

Do you have any diseases we should be aware of?

Pronoun you would like to be referred to by;
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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