Tattoo Consent Form

Glassmoontattoo.com

1151 S. Huron street, Denver, CO 80223

Full Name

First NameLast Name

Pronouns

(Ex. She/her)

Age

Upload government issued photo ID

Browse Files

Date of Birth

Date

Phone Number

Area CodePhone Number

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Tattoo Description

Body Location of Tattoo

Appointment Date and Time

Do you have any allergies such as:

Diseases:

Overall Health

Emergency Name and Phone Number

Are you currently on any medication? Please list:

How many hours will you have eaten before your tattoo appointment?

I have truthfully represented to Glass Moon Tattoo Co. that I am over the age of eighteen (18).

I acknowledge that it is not reasonably possible for the representatives and employees of Glass Moon Tattoo Company to determine whether I might have an allergic reaction to the dyes, pigments or processes used in my tattoo, and I agree to accept the risk that such a reaction is possible.

I acknowledge that I have advised my tattoo artist of any condition that might affect the healing of this tattoo. I do not have medical or skin conditions such as but not limited to: acne, scarring (keloid), eczema, psoriasis, freckles, moles, or sunburn in the area to be tattooed that may interfere with said tattoo. If I have any type of infection or rash anywhere on my body, I will advise my tattooer.

I am not pregnant or nursing.

I am not under the influence of alcohol or drugs.

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 instructions and I agree to follow them while my tattoo is healing. I agree that any touch-up work needed, due to my own negligence, will be done at my own expense. This includes sun and ultraviolet frequency damage.

I acknowledge Glass Moon Tattoo Co. does not offer refunds.

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 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 that if my tattoo is a symbol, or something written in a language other than English, Glass Moon Tattoo Co. and my tattooer are not responsible for what it may or may not mean.

I acknowledge that if my tattoo includes text, that I am responsible for the correct spelling, grammar and punctuation. I have proofread the text before it is applied as a tattoo.

I acknowledge that variations 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 is dark, the colors will not appear as bright as they do on light skin. I also understand that over time, the colors and clarity of my body art will fade due to unprotected sun exposure and the naturally occurring dispersion of pigment under the skin

I acknowledge the decision for obtaining my tattoo is my own free will and choice. I consent to the location of the tattoo and the performance of the tattoo procedure.

I acknowledge and agree to following any and all instructions provided to me regarding the maintenance of a sanitary environment while I am being tattooed.

I agree that the tattoo design is correctly drawn to my specifications and I agree to allow for artist interpretation of the image.

I agree to immediately notify my tattooer if I feel lightheaded, dizzy and/or faint before, during or after the procedure. Failure to do so releases Glass Moon Tattoo Co. and my tattooer of all responsibility.

I agree that I have read the supplementary COVID-19 Pre-Screen and Consent Form also sent to me by my tattooer, and that I have filled it out truthfully and agree to all new policies in place.

I agree to reimburse the artist and Glass Moon Tattoo for any attorney fees and costs incurred in any legal action I bring against the artist and Glass Moon Tattoo Co. in which the artist or glass moon is the prevailing party. I agree that the courts of Colorado in Denver County shall have personal jurisdiction and venue over me and shall have exclusive jurisdiction for the purpose of litigating any dispute arising out of or related to this agreement

I release all rights to any photographs taken of me and my body art and give consent in advance to their reproduction in print or electronic form, please notify your artist if you do not consent

Signed Date

Date

Client Signature

Any questions about either consent form or anything else prior to your appointment, please email me your respective tattoo artist. Thank you for choosing Glass Moon Tattoo Company!

Ink brand/lot number/expiration:

Needle groupings/expiration dates

This is a fill in the blanks field. Please add appropriate blank fields and text.

Glass Moon Tattoo Co.

Client Information

Health Questionnaire

Acknowledgment and Waiver

For Tattooer Only