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Lone Sparrow Tattoo Studio 

Client Consent Form 

Please complete this form before receiving any services 

Release and Waiver:

I acknowledge by signing this waiver that my artist has given me the full opportunity to ask all questions I might have in regards to before, during and after the tattoo process. All my questions have been answered to my full and total satisfaction.

I Agree

I specifically acknowledge that I have been advised of the facts and matters set forth below, and by checking the box I agree as follows: 

I Agree

I accept the risks of any allergic reactions to any products used during the tattoo process or after care bandages and hereby release Lone Sparrow LLC and my artist from liability for any such allergic reaction, injury or complication. 

I Agree

I understand that it is my responsibility to inform my artist of any medical history, medication or allergies and failing to do so could affect my tattoo experience. 

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 understand 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 that could impair my judgement at the time of my appointment and my appointment will be ended and full cost of the tattoo appointment will be required if at any point I become impaired, disruptive, disrespectful, or move excessively.

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 is applied from all claims, damages, or legal actions arising from or connected in any way with my tattoo. 

I Agree

I understand that tattoos are a permanent body modification and any skin treatment, laser hair removal, plastic surgery, or other skin altering procedures, may result in adverse changes to my tattoo.

I Agree

I agree to inform my artist of any changes prior to starting my tattoo procedure. I have agreed to the design, pricing, size, location, and color of the tattoo. Therefore, giving my artist permission to start the procedure.

I Agree

I understand Lone Sparrow LLC and the artists are not responsible for any meaning, interpretations, translation, spelling of any symbol or text. I understand it is my responsibility to research the design prior to the appointment.

I Agree

I understand the quality of work may differ based off of the condition of my skin, medical conditions, age, texture of skin, location, my ability to be still during the tattoo process, the experience of my artist and how well I take care of my tattoo.

I Agree

I understand that all tattoos will fade over time due to the immune systems natural reaction to attack the ink as its a foreign pigment, with certain locations, fine line, micro, color having a higher rate of fading/lightening over time .I acknowledge I am responsible for any touch ups needed.

I Agree

I acknowledge Lone Sparrow LLC has a No Refund policy and I'm required to pay the full amount at time of service. All digital payments are subject to surcharges and fees.

I Agree

I understand that getting a tattoo while breastfeeding/chestfeeding carries potential, though uncommon, risks of infection and I accept full responsibility for any health-related consequences to myself or my child.

I Agree

I understand that Lone Sparrow LLC and the artists assumes no responsibility for any property lost, stolen or damaged, please be sure to take all personal belongings with you.

I Agree

April 14, 2026

Please select who will be participating...
AdultMinor
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First Client’s (LEGAL) Name
First Name*
Middle Name
Last Name*
Phone*
By checking this box, you agree to receive text message updates from the business who owns this Smartwaiver form. Msg & data rates may apply. Msg frequency is recurring. Reply STOP to opt out.
First Client’s Date of Birth*
Date of Birth
Appointment Information
Who is the artist for this appointment?*
Name or Pronoun you would like to be referred to by: (She/Her, He/Him, They/Them, etc.) Please verbally disclose your pronouns to your artist directly.
Would you like a silent appointment? (No chit chatting, just relaxing) *
No
Yes

Medical History:

DO YOU HAVE AN ALLERGY TO LATEX OR ADHESIVES? (Derm-shield/Sani-derm/second skin, bandaid adhesives/Medical tapes)*
No
Yes

Do you have any medical conditions that could affect your tattoo experience? (Seizures, Blood Pressure, POTs, Diabetes, syncope, Sensory processing Disorder, Anxiety etc.) *

Do you have any transmittable diseases? (HIV,HEPATITIS,AIDS,HERPES,MRSA,STAPH) *

Are you on any medications (otc & prescription) that could affect your appointment? (Ibuprofen, Blood thinners, antibiotics, immunosuppressants) *
Do you have any skin conditions? (eczema, prone to keloids/scarring, psoriasis etc.) *
Please list all allergies (food/metals/skin/medications) **Let your artist know if you're allergic to any metals** *
Are you breastfeeding/chestfeeding?*
No
Yes
First Client’s (LEGAL NAME) Signature*
Client’s (LEGAL) 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:*
Valid Identification

Please be sure to take CLEAR pictures of documents.

Uploads must be of FRONT of PHOTO ID


Upload a State ID / Driver License / Passport / Birth Certificate *
  
Valid file types: JPG, GIF, PNG, and PDF

**If documents are unclear a new consent form will be required**

Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
Emergency Contact's Relation to Participant
Parent or Legal Guardian's Email Address
Email
Check to receive information, news, and discounts by e-mail.
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
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 Legal Guardian's Name
First Name*
Middle Name
Last Name*
Relationship*
Phone*
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 Legal Guardian's Date of Birth*
Date of Birth
Appointment Information
Who is the artist for this appointment?*
Name or Pronoun you would like to be referred to by: (She/Her, He/Him, They/Them, etc.) Please verbally disclose your pronouns to your artist directly.
Would you like a silent appointment? (No chit chatting, just relaxing) *
No
Yes

Medical History:

DO YOU HAVE AN ALLERGY TO LATEX OR ADHESIVES? (Derm-shield/Sani-derm/second skin, bandaid adhesives/Medical tapes)*
No
Yes

Do you have any medical conditions that could affect your tattoo experience? (Seizures, Blood Pressure, POTs, Diabetes, syncope, Sensory processing Disorder, Anxiety etc.) *

Do you have any transmittable diseases? (HIV,HEPATITIS,AIDS,HERPES,MRSA,STAPH) *

Are you on any medications (otc & prescription) that could affect your appointment? (Ibuprofen, Blood thinners, antibiotics, immunosuppressants) *
Do you have any skin conditions? (eczema, prone to keloids/scarring, psoriasis etc.) *
Please list all allergies (food/metals/skin/medications) **Let your artist know if you're allergic to any metals** *
Are you breastfeeding/chestfeeding?*
No
Yes
Parent or Legal 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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