Ink'd by Cherry Tattoo Studio Consent Form

Tattoo Consent Form

Application for Tattoo, Release of Liability and Waiver to All Claims.
Client Information

Please fill out the information below to the best of your knowledge. (*required fields)
Full Name*

First NameLast Name
Age*
Date of Birth*

MonthDayYear
Date
Phone Number*

Area CodePhone Number
Email*
example@example.com
Tattoo Description*
Please describe your tattoo in detail.
Placement of Tattoo*
Where do you want your tattoo placed?
Health Questionnaire

Please select all that apply to you
Do you have any allergies such as:*

AntibioticsMetalsSoapsLatexAlcoholCosmeticsAdhesivesPetroleumLanolin OilLidocaineShellfishNoneOther
Diseases:*

HepatitisTuberculosisGonorrheaSyphilisHIV/AIDSHerpesStaphAuto-Immune DisorderAsthmaCOVID-19InfectionsNoneOther
Overall Health*

Heart DiseaseHigh Blood PressureDiabetesCurrently Pregnant or BreastfeedingProne to FaintnessSkin Disease/RashEpilepsyHemophiliaProne to Scarring/KeloidsPsoriasisBlood ThinnersEczemaNoneOther
Emergency Name and Phone Number
(Optional)
Are you currently on any medication? Please list:
(Optional, but encouraged)
Do you have other Tattoos?
If so how many?
Acknowledgment and Waiver

By completing and signing this form, I acknowledge that I have been given the full opportunity to ask any and all questions which I might have about obtaining a tattoo from Ink'd by Cherry Tattoo Studio, and that all of my questions have been answered to my full and total satisfaction. I specifically acknowledge that I have been advised of the facts and matters set forth, and I agree as follows:
I have truthfully represented to Ink'd by Cherry Tattoo Studio that I am over the age of eighteen (18).*

I agree
I acknowledge that it is not reasonably possible for the representatives and employees of Ink'd by Cherry Tattoo Studio to determine whether I might have an allergic reaction to the dyes, pigments or processes used in my tattoo, and I agree to accept the risk that such a reaction is possible.*

I agree
I acknowledge that I have advised my tattoo artist of any condition that might affect the healing of this tattoo. I do not have medical or skin conditions such as but not limited to: acne, scarring (keloid), aczema, 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.*

I agree
I am not pregnant or nursing.*

I agree
I am not under the influence of alcohol or drugs.*

I agree
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 instructions and I agree to follow them while my tattoo is healing. I agree that any touch-up work needed, due to my own negligence, will be done at my own expense. This includes sun and ultraviolet frequency damage.*

I agree
I acknowledge that Ink'd by Cherry Tattoo Studio does not offer refunds.*

I agree
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 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.*

I agree
I acknowledge that if my tattoo is a symbol, or something written in a language other than English, that Ink'd by Cherry Tattoo Studio are not responsible for what it may or may not mean.*

I agree
I acknowledge that if my tattoo includes text, that I am responsible for the correct spelling, grammar and punctuation. I have proofed the text before it is applied as a tattoo.*

I agree
I acknowledge the decision for obtaining my tattoo is my own free will and choice. I consent to the location of the tattoo and the performance of the tattoo procedure.*

I agree
I acknowledge and agree to following any and all instructions provided to me regarding the maintenance of a sanitary environment while I am being tattooed.*

I agree
I agree to immediately notify my tattooer if I feel lightheaded, dizzy and/or faint before, during or after the procedure. Failure to do so releases Ink'd by Cherry Tattoo Studio and my tattooer of all responsibility.*

I agree
I agree that I have not been in contact of Covid-19 and show no signs of being sick.*

I agree
Signed Date*

MonthDayYear
Hour MinutesAM/PM Option
Client Signature*

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Photo ID*

Please upload a photo of your State issued Identification card.
Cancelof
After you complete consent form please book & pay deposit to confirm your appointment.
If you have any questions, feel free to contact me.

❤️🤟🏼, Ink'd by Cherry

Ink'd by Cherry

Tattoo Studio

17194 Preston Rd., Ste#151

Loft 111

Dallas, TX 75248

(Inside Salon Ovations)

Julie (Cherry)

469.228.8858

Info@inkdbycherry.com
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Tattoo Consent Form

Client Information

Health Questionnaire

Acknowledgment and Waiver