Consent Form

Name

First NameLast Name

Preferred Pronouns

Preferred Name (If not Legal Name)

What type of appointment would you prefer today? *note: if I go quiet during our time I am not upset I am lost in concentration. :)*

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Date of Birth

Date

Are you at least 18 years old or above?

Age:

Which tattoo artist?

How did you hear about us?

Other

If other, please elaborate.

If referred, by whom?

Emergency Contact Name

Emergency Contact Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Primary Care Physician Name

Please do not leave blank. (If not applicable, please enter "Watson Clinic")

Primary Care Phone Number

Please enter a valid phone number.* If using Watson Clinic* (863) 680-7271. Format: (000) 000-0000.

Primary Care Address

Street Address *If using Watson clinic* (1600 Lakeland Hills Blvd)

Street Address Line 2

CityState / Province

Postal / Zip Code

Brief Description of your Tattoo

Tattoo Location on Body

Please take a photo of the front of a *Government Issued ID and upload here.

*Driver's License, Passport, or State Issued ID

I understand that all sales transactions are final and non-refundable.

Have you eaten today?

Would you like to list any prescription medications you are currently taking in case of a medical emergency?

Put N/A if not applicable.

Do you need to consult with a Doctor before getting tattooed today?

RISKS/WAIVER - I acknowledge that I have been fully informed of the inherent risks, associated with getting a tattoo. I fully understand that these risks, known and unknown, can lead to injury, including but not limited to infection, scarring, difficulties in detecting melanoma and allergic reactions to tattoo pigment, latex gloves, and/or soap. Having been informed of the potential risks, I still wish to proceed with the tattoo application and I freely accept and expressly assume any and all risks. I agree TO WAIVE AND RELEASE to the fullest extent permitted by law each of the Artist and the Studio from all liability whatsoever, for any and all claims or causes of action that I, my estate, heirs, executors or assigns may have for personal injury or otherwise, including any direct and/or consequential damages, which result or arise from my tattoo, whether caused by the negligence or fault of either the Artist or the Tattoo Studio, or otherwise.

HEALING - The Artist and the Tattoo Studio have given me instructions on the care of my tattoo while it's healing, and I understand them and will follow them. I acknowledge that it is possible that the tattoo can become infected, particularly if I do not follow the instructions given to me. If any touch-up work to the tattoo is needed due to my own negligence, I agree that the work will be done at my own expense.

INFLUENCE - I am not under the influence of alcohol or drugs, and I am voluntarily submitting to be tattooed by the Artist without duress or coercion. Do you affirm this statement?

Do you have any bloodborne or transmittable diseases that could impair your ability to be tattooed today.

Do you have diabetes?

Do you have epilepsy, hemophilia, or a heart condition?

Are you currently pregnant or nursing?

LEGAL ACTION - I agree to reimburse each of the Artists and the Tattoo Studio for any attorneys' fees and costs incurred in any legal action I bring against either the Artist or the Tattoo Studio and in which either the Artist or the Tattoo Studio is the prevailing party. I agree that the courts of Florida 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. Do you affirm this statement?

QUESTIONS & UNDERSTANDING - I acknowledge that I have been given adequate opportunity to read and understand this document, that any and all of my questions have been answered, that it was not presented to me at the last minute, and I understand that I am signing a legal contract waiving certain rights to recover against the Artist and the Tattoo Studio.

I hereby declare that I am of legal age (with valid proof of age) and am competent to sign this Agreement.

PHOTOGRAPHY - I release all rights to any photographs, videos or audios recorded of me or any part of my likeness and the tattoo or body piercing and give consent in advance to their reproduction in print or electronic form. (If you do not tick this provision, please advise your Artist).

I AGREE AND ACKNOWLEDGE THAT I HAVE ANSWERED THESE QUESTIONS TRUTHFULLY AND TO THE BEST OF MY ABILITY. BY TYPING MY NAME BELOW, I AM USING THIS AS MY ELECTRONIC SIGNATURE AND SEALING THIS AGREEMENT. MY ELECTRONIC SIGNATURE: