Tattoo Consent Form

Name

First NameLast Name

Age

Birth Date

Date

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Format: (000) 000-0000.

Email

example@example.com

Artist's Name

First NameLast Name

Appointment date

Date

Artist Email

example@example.com

Brief description of tattoo and location:

Are you under the influence of drugs or alcohol?

FEMALE ONLY: Are you pregnant or nursing?

Do you have a communicable disease?

Do you have any allergies?

Do you have any skin conditions?

List all allergies and skin conditions a(e.g. Rashes, eczema, infection, psoriasis, freckles, etc.)

If yes, please identify the condition.

Please tell about your medical history (e.g. DIabetes, Cardiovascular Disease, Epilepsy, Blood-related disease etc.)

If yes, please identify the condition.

Client Signature

Signed Date

Date

By filling out this agreement I grant permission for photographs and videos to be taken of my tattoo on today’s date.

I understand that photographs and videos taken of my tattoo 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 and videos. I understand that my name may or may not be included/credited in any form of publication unless requested otherwise.

blanks

This is how my artist may use photographs and videos of my tattoo:

Client Signature

Signed Date

Date