Cherry Lemon Consent Form

Full Name

Email

example@example.com

Phone Number

+44Phone Number

Date of appt.

Date

Date of Birth

Date

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Procedure and location

I.e. tattoo of bird on left forearm

Any other access needs or allergies

Age as of your appt.

(must be 18 or older)

ID Upload Point (Challenge 25)

Please ensure the photo is high quality/visible.

I acknowledge I have been advised of the facts and matters set forth below and I agree as follows:

If I have diabetes, epilepsy, hepatitis, hemophilia, HIV-AIDS or any other communicable disease, heart condition or take medicine which thins the blood I have advised my tattooer.
I am not pregnant or nursing. I am not under the influence of alcohol or drugs.
If I have used numbing products before my appointment, I will inform my artist before we begin the procedure. I understand that numbing agents can cause allergic reactions, and can affect the healing process of my tattoo negatively for which the artist is not responsible.
If I am getting a text tattoo, I am responsible for ensuring that the spelling is correct. My artist is no liable for any spelling errors. This also applies to roman numerals.
I acknowledge it is not possible for the representatives and employees of this tattoo shop to determine whether I might have an allergic reaction to the pigments or processes used in my tattoo, and I agree to accept the risk that such a reaction is possible.

I acknowledge that infection is always possible as a result of the obtaining of a tattoo, particularly in the event that I do not take proper care of my tattoo. I agree to follow aftercare instructions while my tattoo is healing.
I realize that variations in color and design may exist between any tattoo as selected by me and as ultimately applied to my body.
I understand that if I have any skin treatments, laser hair removal, cosmetic surgery or other skin altering procedures, it may result in changes to my tattoo.
I acknowledge that a tattoo is a permanent change to my appearance and do not hold my tattooer liable for or of the ability to later change or remove my tattoo.
I acknowledge I am over the age of eighteen and that I have truthfully represented to my tattooer that the obtaining of a tattoo is by my choice alone.
I fully understand the tattoo artist does not act as a medical professional.
I agree to release and discharge my artist from any and all claims, damages, or legal actions arising from or connected to my tattoo and the procedure used in the application of my tattoo.
I consent to the application of the tattoo. My tattoo artist and I recognize that I may revoke this consent at any time before or during the tattoo procedure.
If my tattoo is in need of a (free) touch up, I will inform my artist within 6 weeks of when the appointment took place. I understand that if I do not meet this time frame, a minimum payment of £70 will be required.
If the healing of my tattoo is affected by my own actions (e.g., going swimming before it is healed), then I am liable to pay for reworking or touching up the tattoo.
If I am to get a tattoo on my face, neck, or hands, I understand the social implications of this, and have given thorough consideration to the placement of the tattoo.

By filling out this agreement I grant permission for my photos to be taken on today’s date.

I understand that photographs taken of me during this session may be used, wholly or in part, on the internet, in any publication, portfolio, or display, or in any other print or electronic medium as this artist chooses, unless otherwise specified below.
I confirm I am 18 years of age or older. I will make no monetary or other claim against this artist for use of the photographs. I understand that my name may or may not be included/credited in any form of publication unless requested otherwise.

Signature

Tattoo Consent Form