TATTOO WAIVER AND CONSENT FORM

Name*

First NameLast Name

Date of Birth *

Date

Phone Number*

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

Email *

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Please check all to Acknowledge :*

In consideration of receiving a tattoo from Ashley Nicole, I agree to the following: 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 associated with getting a tattoo, I still wish to proceed with the Tattoo application, and I freely accept and expressly assume any and all risks that may arise from tattooing.

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I do not have any 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.

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If I have diabetes, epilepsy, hepatitis, hemophilia, HIV–AIDS, or any other communicable disease, Heart condition, or I take medication that thins the blood, I have advised, my tattooer. I also acknowledge that I am neither pregnant, nursing, or currently taking antibiotics for an infection.

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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, suggestions, and agreed to take care for my tattoo to the best of my ability. 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.

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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. 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 a 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.

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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.

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Variations in colour and design may exist between the tattoo art I have selected and the actual tattoo when it is applied to my body. I also understand that overtime, the colours and the clarity of my tattoo will fade due to unprotected exposure to the sun, and the naturally occurring dispersion of pigment under the skin.

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Tattoo is a permanent change to my appearance and can only be removed by laser or surgical means, which can be disfiguring and/or costly, and which, in all likelihood, will not result in the restoration of my skin, to its exact appearance before it being tattooed. I also understand that the artist is not responsible for the cost of your laser tattoo removal.

I release all rights to any photographs taken of me and the Tattoo and give consent in advance to their reproduction in print or electronic form. ( If you do NOT initial this provision, please advise and remind your artist not to take any pictures of you and your completed, Tattoo! ).

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I acknowledge that I have been given adequate opportunity to read, and understand this document, that it was not present it 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.

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I acknowledge I am over the age of 18 and that I have read this release form and confirm all the information I have given is correct. I understand that this is a release form, and I agree to be legally bound by it.

Client Signature*

Signed Date*

Date