Rockstar Ink Consent Form

Rockstar Ink Consent Form
Client Information

Please fill out the following contact information.
Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Email *
Emergency Contact Name *

First Name Last Name
Emergency Contact Phone Number *

Area Code Phone Number
Tattoo Information

Please fill out the following information about your tattoo.
Tattoo Artist's Name *
Tattoo Location on Your Body *
Appointment Date *

Month Day Year
Date
Appointment Time *

: Hour Minutes AM/PM Option
Does your tattoo feature text/script that has not been decided upon during your consult? *

Yes No
What are the exact words, phrases, names, dates, etc that will be in your tattoo? *
Please select a font from the list below.
Not seeing the font you want? Check out dafont and select one there. Please put the name of you font in the box below.
Consent to Application and Waiver of All Claims
Due to the COVID-19 pandemic there are some additional , if you are having any of the symptoms of infection or have come into contact with someone who tested positive for COVID-19 and have not been isolated for 14 days, please call us and rebook your tattoo appointment.

For information on what the symptoms of COVID-19 are, please see them here.
I confirm that I do not have any of the symptoms of COVID-19 or have been in contact with anyone who has tested positive for COVID-19 in the last 14 days. *

Agree
Are you pregnant? *

Yes No
Are you over 18? *

Yes No
Are you under the influence of drugs or alcohol? *

Yes No
Do you have any allergies or bleeding disorders? *

Yes No
If so, please describe your allergy or disorders.
Do you have any medical conditions we should be aware of? *

Yes No
If so, please describe your medical conditions.
Do you have HIV/AIDS, Hepatitis, or other communicable diseases? *

Yes No
I understand that tattoos are permanent and there are no refunds. *

Agree
I realize that colour tattoos may vary depending on skin type. *

Agree
I agree to follow the aftercare instructions listed below. *

Agree
I understand that complications may occur such as infections or allergic reactions. *

Agree
I have answered all the above questions truthfully. *

Agree
I have approved the design/stencil the artist completed for me including spelling, and I approve the tattoo to be completed as I saw it today. *

Agree
If I have any issues with my tattoo, I will follow up with my tattoo artist and my family doctor immediately. *

Agree
Please sign below. Select Tablet/Touchscreen if you are signing with your finger, or Desktop to sign with your legal name as it appears on your valid government issued I.D.
How would you like to sign? *

Tablet/Touchscreen Desktop
Sign with your finger or stylus. *

Clear
Sign with your legal name. *
Should be Empty:

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Rockstar Ink Consent Form

Client Information

Tattoo Information

Consent to Application and Waiver of All Claims