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Body Art Tattoo Consent Form

Prior to the performance of body art, the client shall read, complete, and sign an Informed Consent Form per California Health & Safety Code 119303

Artist: Mabel
First Client Name
First Name*
Middle Name
Last Name*
Phone*
First Client Date of Birth*
Date of Birth

I, the client, acknowledge by signing this form that I have been given the full opportunity to ask any questions I may have pertaining to the tattoo procedure and that all questions have been answered. I have read through the content and agree with and have answered all questions to the best of my ability.

First Client Signature*
Second Client Name
First Name*
Middle Name
Last Name*
Client Date of Birth*
Date of Birth

I, the client, acknowledge by signing this form that I have been given the full opportunity to ask any questions I may have pertaining to the tattoo procedure and that all questions have been answered. I have read through the content and agree with and have answered all questions to the best of my ability.

Third Client Name
First Name*
Middle Name
Last Name*
Client Date of Birth*
Date of Birth

I, the client, acknowledge by signing this form that I have been given the full opportunity to ask any questions I may have pertaining to the tattoo procedure and that all questions have been answered. I have read through the content and agree with and have answered all questions to the best of my ability.

Fourth Client Name
First Name*
Middle Name
Last Name*
Client Date of Birth*
Date of Birth

I, the client, acknowledge by signing this form that I have been given the full opportunity to ask any questions I may have pertaining to the tattoo procedure and that all questions have been answered. I have read through the content and agree with and have answered all questions to the best of my ability.

Fifth Client Name
First Name*
Middle Name
Last Name*
Client Date of Birth*
Date of Birth

I, the client, acknowledge by signing this form that I have been given the full opportunity to ask any questions I may have pertaining to the tattoo procedure and that all questions have been answered. I have read through the content and agree with and have answered all questions to the best of my ability.

Sixth Client Name
First Name*
Middle Name
Last Name*
Client Date of Birth*
Date of Birth

I, the client, acknowledge by signing this form that I have been given the full opportunity to ask any questions I may have pertaining to the tattoo procedure and that all questions have been answered. I have read through the content and agree with and have answered all questions to the best of my ability.

Seventh Client Name
First Name*
Middle Name
Last Name*
Client Date of Birth*
Date of Birth

I, the client, acknowledge by signing this form that I have been given the full opportunity to ask any questions I may have pertaining to the tattoo procedure and that all questions have been answered. I have read through the content and agree with and have answered all questions to the best of my ability.

Eighth Client Name
First Name*
Middle Name
Last Name*
Client Date of Birth*
Date of Birth

I, the client, acknowledge by signing this form that I have been given the full opportunity to ask any questions I may have pertaining to the tattoo procedure and that all questions have been answered. I have read through the content and agree with and have answered all questions to the best of my ability.

Ninth Client Name
First Name*
Middle Name
Last Name*
Client Date of Birth*
Date of Birth

I, the client, acknowledge by signing this form that I have been given the full opportunity to ask any questions I may have pertaining to the tattoo procedure and that all questions have been answered. I have read through the content and agree with and have answered all questions to the best of my ability.

Tenth Client Name
First Name*
Middle Name
Last Name*
Client Date of Birth*
Date of Birth

I, the client, acknowledge by signing this form that I have been given the full opportunity to ask any questions I may have pertaining to the tattoo procedure and that all questions have been answered. I have read through the content and agree with and have answered all questions to the best of my ability.

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:*
Upload Valid Driver's License/Photo ID/Passport *
  
Valid file types: JPG, GIF, PNG, and PDF
Tattoo Placement: *
Brief Tattoo Description *
Parent or Guardian's Email Address
Email*
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
Medical History

Please read the following information carefully. If any of these apply to you, discuss them with your practitioner prior to having your tattoo. Please check all that apply to you.

Have you had alcohol, caffeine, ibuprofen, aspirin, or energy drinks within the past 24 hours?*
No
Yes
AIDS/HIV
Allergies
Any form of seizure causing conditions
Asthma
Diabetes
Hemophilia/other blood clotting disorders
Herpes/Cold Sores
Keloid/Scarring in procedure area
On blood thinner/medication
Pregnant/Nursing
STD/STI
Skin Allergies/Conditions
Not Applicable
If applicable, please not any allergies you may have:
If applicable, please note any medical conditions:

I have been informed and agree as follows:


›› I understand that if a deposit has been sent, it is nonrefundable. Once services have begun, I understand that there are no refunds and I will not request for any.

›› I understand the inherent risk associated with receiving a tattoo. Therefore, I understand that these risks, known and unknown, can lead to injury including but not limited to; scarring, infections and/or allergic reactions to: tattoo ink pigments, nitrile, green soap, and other equipment used in the procedure. Having been informed of these potential risks, I wish to proceed with the application of my tattoo freely and expressively, assuming all possible risks that may arise. 

›› I understand that every care has been taken to ensure that this procedure has been carried out in a hygienic manner, and the aftercare of the tattoo is my sole responsibility. I understand that the reactions to pigments is still possible, even after the tattoo has recovered. I will follow the aftercare provided to me by my practitioner.

›› I am the person on the legal ID presented as proof that I am at least 18 years of age

›› I am not under the influence of any drugs or alcohol.

›› If I suffer from Hepatitis B/C, HIV, AIDS, STD, STI, Herpes, or any other risk factors for bloodborne pathogen exposure, or any communicable disease, I have informed the Artist of the fact. The Artist may have the choice in performing the procedure.

›› I am aware that tattoo inks, dyes, and pigments have not been approved by the FDA and the health risks on these products are unknown.

›› I agree to release and forever discharge, and hold harmless the Artist the use of images of my tattoo(s) for marketing and/or publishing purposes in various media outlets such as the internet, social media, magazine, printed, and/or television, etc.

›› I agree to release and forever discharge, and hold harmless, the Artists from any and all claims of negligence, damages, or legal actions arising from or connected in any way with my tattoo, procedure, and conduct used in my tattoo and assume all responsibility for the decisions made consenting to this permanent procedure.

›› I acknowledge that I am signing a legal contract waiving certain rights to recover damages against the Artist.


By printing my full name and checking the box, I agree and give consent to the application of the tattoo, and understand the accountability/process/risks upon receiving one. I acknowledge that the information I have provided is true and am to assume any and all risks that may arise from the tattoo. I agree to all the aforementioned terms. *
I Agree
Full Name *
Date *
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*
Date of Birth

I, the client, acknowledge by signing this form that I have been given the full opportunity to ask any questions I may have pertaining to the tattoo procedure and that all questions have been answered. I have read through the content and agree with and have answered all questions to the best of my ability.

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. 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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