Bl00dyMaryInk Tattoo Consent Form

Tattoo Consent Form

Release of Liability and Waiver to All Claims
Client Information
Full Name*

First NameLast Name
Age*
Date of Birth*

MonthDayYear
Phone Number*

Area CodePhone Number
Email*
example@example.com
Tattoo Description*
i.e spiderweb on left forearm
Health Questionnaire

Select all that apply to you. 100% CONFIDENTIAL
Do you have any allergies such as:*

SoapsLatexAlcoholPetroleumLidocaineNONEOther
Diseases:*

HepatitisGonorrheaSyphilisHIV/AIDSHerpesStaphAuto-Immune DisorderInfectionsNONEOther
Overall Health*

High Blood PressureProne to FaintnessSkin Disease/RashEpilepsyProne to Scarring/KeloidsPsoriasisBlood ThinnersEczemaNoneOther
Acknowledgment and Waiver

By signing this form, I confirm the following:
I am over the age of eighteen (18).*

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 BL00DYMARYINK does not offer refunds.*

I agree
I acknowledge that a tattoo is a permanent change to my body.*

I agree
I consent to photographs of my tattoo for portfolio and promotional use.*

I agree
I acknowledge the decision for obtaining my tattoo is my own free will and choice.*

I agree
I acknowledge that I have advised my tattoo artist of any condition that might affect the healing of this tattoo.*

I agree
I understand that receiving a tattoo involves risks including but not limited to infection, scarring, allergic reaction, and dissatisfaction with the outcome, and I voluntarily accept these risks.*

I agree
I acknowledge that the tattoo artist cannot predict how my skin will react, how the tattoo will heal, or how it may change over time due to age, weight changes, or sun exposure.*

I agree
I agree to release, waive, and hold harmless the tattoo artist, Mary Pruitt, from any and all claims, damages, or legal actions arising from or connected to my tattoo procedure, including any costs of medical care or legal fees.*

I agree
By signing below, I acknowledge that I have read and fully understand this release, and I am voluntarily signing it without coercion.
Client Signature*

Clear
Signed Date*

MonthDayYear
Date
Photo ID*

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Tattoo Consent Form

Client Information

Health Questionnaire

Acknowledgment and Waiver

By signing below, I acknowledge that I have read and fully understand this release, and I am voluntarily signing it without coercion.