Guerilla Needles Tattoo Consent Form

Would you like to join my priority mailing list for new flash drops, news on my travels, cancellation spaces and events ♥️

Yes please - sign me up!

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 ♥️

Date

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 ♥️

I confirm that the information I have provided on this consent form is correct and to the best of my knowledgeI understand the known potential risks of tattooing ( including but not limited to: localised swelling, scarring, blood poisoning, localised infection, allergic reactions to pigments) I agree to seek medical advice in the event of adverse effects, and to notify my tattoo artistI confirm that I am not pregnant or breastfeedingI agree to follow the aftercare instructions given by my artist. If I choose to not follow this advice, I acknowledge that my tattoo may become infected and not heal or age well : and that this is my responsibility and not that of my artistI understand that tattooing is an art,being applied to a living body and that there will be variations compared to the designI understand that the skin is a living organ, and as such the healed result will look different to the fresh tattoo. I understand that the tattoo will age in my skin over the years. Ink can spread a little under the skin and lines may appear thicker over time.I confirm that I am over 18 years oldI confirm that I am not under the influence of drugs or alcoholI understand that I can ask questions at any point of the process and speak up if I am uncomfortable with any part of the appointment

Do you consent to images and videos of you and your tattoo being shared on social media? ♥️

YesNo

If you answered yes, please provide your instagram handle below ♥️

I consent to be tattooed by Sarah Terry / Guerilla Needles ♥️

Yes

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