Tattoo Release Form

I acknowledge that by signing this agreement I have been given the full opportunity to ask any and all questions which I might have about obtaining of a tattoo and that all of my questions have been answered to my full satisfaction. I specifically acknowledge that I have been advised of the facts and matters set forth below and agree as follows:

If I have any allergies, diabetes, epilepsy, hemophilia, heart conditions or am I taking medications which thins the blood (such as Warfarin or Coumadin) I have advised my tattooer.

I am not pregnant. I am not under the influence of alcohol or drugs. This includes prescription pain killers and medical marijuana.

I do not have medical or skin conditions such as, but not limited to, acne, keloid scaring, eczema, psoriasis, moles or sunburn in the area to be tattooed that may interfere with my tattoo.

I acknowledge it is not reasonably possible for the representatives and employees of Pierce Hearts Tattoo Parlor to determine whether or not if I might have an allergic reaction to pigments or the process involved in my tattoo and I agree to accept the risk that such a reaction is possible.

I acknowledge it is not reasonably possible for the representative and employee of Pierced Hearts Tattoo Parlor to determine whether or not I might feel faint, dizzy or otherwise temporarily impaired as a result of obtaining this tattoo. I understand that I should not operate heavy equipment or machinery after receiving a tattoo and I accept full responsibility as to how I will travel once that tattoo is complete.

I acknowledge that infection is always possible as a result of obtaining a tattoo particularly in the event that I do not take proper care of my tattoo. I have received aftercare suggestions and I agree to follow them while my tattoo is healing. I agree that any touch-up work required due to my own negligence will be done at my own expense.

I realize that variation in color and design may exist between any tattoo as selected by me and as ultimately applied to my body. I understand that if my skin color is dark, the colors will not appear as bright as they do on lighter skin.

I understand that if I have any skin treatment, laser hair removal, plastic surgery or other altering Procedures, it may result in adverse changes to my tattoo.

I acknowledge that a tattoo is a permanent change to my appearance and that no representations have been made to me as to the ability to later change or remove my tattoo. To my knowledge, I do not have a physical, mental or medical impairment or disability which might affect my well-being as a direct or indirect result of my decision to have a tattoo.

I acknowledge I am 18 years or older and have truthfully represented to my tattooer that the obtaining of a tattoo is my choice alone. I consent to the application of the tattoo and the actions or conduct of the representatives and employees of Pierced Hearts Tattoo Parlor reasonably necessary to perform the tattoo procedure.

I have not contracted MRSA or a severe staph infection within the last 12 months.

In order for Pierced Hearts to reduce the number of people in the facility and maintain social distancing measures, I agree to limit the number of people that accompany me to ONE. I understand that any extra people that I bring will be asked to wait outside of our facility.

I agree to be a respectful patron and I WILL TURN OFF MY CELL PHONE. PLEASE TAKE CALLS, FACETIME, ETC OUTSIDE AND KEEP YOUR PHONE ON SILENT.

You must provide a copy of your ID. We can only except a state issued ID cards, Drivers License, or military ID. Please select image and upload.*

Browse Files

Please provide proof of vaccination.

Browse Files

Please sign using touch pad, touch screen or mouse.*

PIERCED HEARTS TATTOO PARLOR

PIERCED HEARTS TATTOO PARLOR