HEYJOTATS CONSENT FORM

NAME

DATE OF BIRTH

Date

DATE OF APPOINTMENT

Date

TIME OF APPOINTMENT

Hour Minutes

AM/PM Option

PROOF OF IDENTIFICATION

DRIVERS LICENSE, PROOF OF AGE OR PASSPORT - PLEASE BLOCK OUT LICENSE/PASSPORT NUMBER/CARD NUMBER BEFORE SUBMITTING.

I am 18 years of age or older as of my tattoo appointment

Have you consumed any alcohol in the last 8 hours?

Are you under the influence of drugs?

In the past 14 days have you felt unwell or had any symptoms of Covid-19 (such as fever, coughing, shortness of breath), returned from overseas, had any contact with a confirmed or suspected case of Covid-19?

Have you taken aspirin, ibuprofen or blood thinners in the last 24 hours?

Are you prone to heavy bleeding?

Do you have a latex allergy?

I do not have any medical or skin conditions such as but not limited to: acne, scarring (Keloid), eczema, psoriasis, moles or sunburn in the area to be tattooed that may interfere with the tattoo. If I have any type of infection or rash anywhere on my body, I will advise my tattoo artist.

I willingly submit to these procedures with a full understanding of possible complications such as but not limited to, infection, allergic reaction or rejection of the ink and in the event of, do not hold my tattoo artist responsible.

I do not have diabetes, epilepsy, hepatitis, HIV, AIDS or any other communicable disease.

Neither the artist nor the tattoo studio is responsible for the meaning or spelling of the tattoo I have agreed to. I have checked and approved the tattoo stencil.

I acknowledge that by having this tattoo performed that I am making a permanent change to my body and no claims have been made regarding the ability to undo the changes made.

I understand that the tattooist's suggestions and guidelines for the best care of my tattoo is offered in accordance with their training and experience, but is not to be confused with professional medical advice.

I accept to release and forever discharge my tattoo artist and their studio from any and all claims, damages and legal actions arising from or connected in any way with my tattoo of the procedures and conduct used to apply my tattoo.

BY SUBMITTING THIS FORM:

I release all rights to any photographs taken of me and the tattoo and give consent in advance to the reproduction in print or electronic form. I acknowledge that I had the opportunity to ask questions regarding this procedure and all questions were answered to my satisfaction.

I acknowledge I have been given the full opportunity to ask any questions which I might have about obtaining a tattoo from @heyjotats and that all my questions have been answered to full and total satisfaction.

I confirm that the information on this form is true and correct.

Signature

@HEYJOTATS CONSENT FORM

ACKNOWLEDGEMENT AND CONSENT