Guerilla Needles Tattoo Consent Form

Guerilla Needles Tattoo Consent Form

Please answer all questions below
Would you like to join my priority mailing list for new flash drops, news on my travels, cancellation spaces and events ♥️
Name ♥️

First NameLast Name
Email ♥️
example@example.com
Address ♥️

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number ♥️
Shop where you are being tattooed ♥️
Appointment Date ♥️

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Please upload a photo of your photo ID ( driving licence or passport) ♥️
Emergency contact name ♥️
Emergency contact phone number ♥️
Brief description of the tattoo ♥️
Placement of tattoo on your body ♥️
Do you have any of the following conditions? Please tick all that apply ♥️
If you have ticked any of the above boxes, please give details below ♥️
Are you on any medications that might affect the tattoo process? Please provide details below ♥️
Please indicate that you agree to each of the following using the tick boxes ♥️
Do you consent to images and videos of you and your tattoo being shared on social media? ♥️
If you answered yes, please provide your instagram handle below ♥️
I consent to be tattooed by Sarah Terry / Guerilla Needles ♥️
Signature ♥️
DATA PROTECTION : The information you provide me will not be shared with third parties ; it will be stored in a secure place and will be destroyed in compliance with data protection laws
Should be Empty: