FREE CLIENT CONSENT FORM

Please check any conditions listed below that apply to you.

FILL OUT COMPLETELY (N/A IS NOT AN ANSWER):

How long has it been since you last ate? __________________________________________________________

Do you have any allergies? ____________________________________________________________________

List all medications you are currently taking. _______________________________________________________________

Are there any other known MEDICAL CONDITIONS or CONTAGIOUS DISEASES that may
affect your TATTOO procedure? _________________________________________________________________________________

• I hereby certify that to the best of my knowledge this information is correct.
• All Questions have been answered to my satisfaction.
• I agree the said TATTOO is correctly drawn to my specifications.
• I understand that the said TATTOO is PERMANENT.
• This is to certify that I am at LEAST 18 YEARS OF AGE.
• I am not under the influence of ALCOHOL OR DRUGS.
• I understand there is a possibility of an allergic reaction.
• I understand there is a possibility of an infection.
• I agree to allow for ARTIST INTERPRETATION.
• I agree to follow all instructions concerning the care of my TATTOO.
• I understand that there is a chance I might feel lightheaded, dizzy and/or
  faint due to my decision to receive a TATTOO.
• I agree to IMMEDIATELY notify the artist in the event I feel lightheaded,
  dizzy and/or faint before, during or after the procedure. Failure to do so
  releases _______________________ and ARTISTS of all responsibility.
• I hereby release ___________________ and ARTISTS of all responsibility for
  the said TATTOO.
• NO REFUNDS.

CUSTOMER’S INFORMATION (FILL OUT COMPLETELY):

If under 18, child and parent(s) signatures need to be done in presence
of a notary. All blanks must be filled in. Parent(s) must be present and proper
identification must be presented prior to service.

I give my permission for my child to receive the said TATTOO.

Parental Signature_____________________________________ Date______ DL#________________________

Minor Signature______________________________________ Date______ DL#________________________

Notary Statement

Sworn and Scribed before me on this ______ Day of _________________ 200___

Notary____________________________________ Seal:

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