Electric Cicada
Tattoo Consent Form
Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
License State
*
If there is any letter in front of the ID number list it here.
License Number
*
Phone Number
*
-
Area Code
Phone Number
E-mail Address
Acknowledgement
I acknowledge that by signing this agreement that I have been given the opportunity to ask any and all questions which I have about the obtaining of a tattoo and that all of my questions have been answered. I specifically acknowledge that I have been advised if the facts and matters set forth below and I agree as follows:
I acknowledge I am over the age of eighteen and that I have truthfully represented that the obtaining of a tattoo is by my choice alone.
*
Yes
No
I consent that I am not pregnant/nursing or under the influence of drugs or alcohol.
*
Yes
No
If I have a condition that might affect the healing of this tattoo, I will advise my tattooer.
*
Yes
No
I accept the risk of possible allergic reactions or infection to the pigments or processes used in my tattoo.
*
Yes
No
I have received aftercare instructions and I agree to follow them while my tattoo is healing.
*
Yes
No
I agree that any touch up work needed, due to individual healing results, or my own negligence; will be done at my own expense.
*
Yes
No
I understand that if I have any skin treatments, laser hair removal, plastic surgery, or other skin altering procedures, it may result in adverse changes to my tattoo.
*
Yes
No
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.
*
Yes
No
I consent to the application of the tattoo and to any actions or conduct of the representatives and employees of the tattoo shop reasonably necessary to perform the tattoo procedure.
*
Yes
No
Artist
Please Select
Reyjon
Talia
Signature
*
Submit
Submit
Should be Empty: