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WAIVER & CONSENT FORM

Have you already scheduled an appointment?
Will the appointment be for you or someone for whom you are legally responsible?
I will be the client participating in the tattoo session
I am the legal parent/custodian/guardian of a minor client participating in the tattoo session
Are you at least 18 years of age?

Clients must be at least 18 years of age or have a consenting adult complete this form.

Date of Birth
Month
Day
Year

Please submit a photo of the front and back of your drivers license or state identification card.

The following questions pertain to the Client's health & medical background information that will be relevant to the appointment.

Have you been hospitalized in the last 12 months?
Yes
No
Are you suffering from a medical condition, illness, or injury?
Yes
No

Examples: diabetes, epilepsy, hemophilia, HIV/AIDS, any communicable disease, heart condition, pregnancy, nursing, blood-thinning medication, or impairment from alcohol or drugs.

Do you have any skin conditions?
Yes
No

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