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WAIVER & CONSENT FORM

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
Have you already scheduled an appointment?
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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