Tattoo Consent Form
Review the consent details and sign to confirm your understanding and agreement before your tattoo session.
Full Name
First Name
Last Name
Date of Birth (You must be 18 or older)
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Consent Acknowledgement
I am at least 18 years old
I am not under the influence of drugs or alcohol
I consent to having photos of my tattoo taken and being used for public promotion
I understand that infection, scarring, or allergic reaction may occur and that it’s not reasonable for tattoo asylum associates to determine whether I will have a reaction to dyes and pigmants.
I acknowledge that I am free of communicable diseases.
I acknowledge that tattoo is a permanent change to my appearance and that no representations have been made to me as to the ability to later change, alter or remove tattoo
I will follow all aftercare instructions and that any touch ups needed because of my own negligence will be done at my own expense
I acknowledge that tattoo inks, dyes and pigments have not been approved by the federal food and drug Administration and the health consequences of using these products are unknown
I agree to release and forever discharge and forever hold harmless tattoo asylum and its associates from any and all claims, damages or legal action arising from or connected in any way with my tattoo or the procedures and conduct used to apply my tattoo and any and all tattoos applied by tattoo asylum
I acknowledge that obtaining this tattoo is my choice alone and I consent to the application of the tattoo and to any actions or conduct of the associates that are reasonable to perform the procedure of the tattoo.
I acknowledge that variation in color and design may exist between any tattoos as selected by me
I have looked over my design, checked the spelling if applicable and give my full consent to the application of my tattoo
I have disclosed relevant medical conditions or allergies
I acknowledge that there is a chance I might feel light headed, dizzy during or being tattooed. I agree to immediately notify the practitioner in the event I feel light headed.
I have been fully informed of the risks of tattooing including but not limited to infection, scarring, difficulties in detecting melanoma and allergic reactions to tattoo pigment, latex gloves and antibiotics. Knowing this, I still wish to proceed with the tattoo appointment.
Tattoo Details
Description of the tattoo
Location of the tattoo
Artist Name
Payment Amount
I acknowledge and understand the following risks associated with tattooing (check all to indicate understanding)
Risk of infection, scarring, or allergic reaction
It is my responsibility to follow aftercare instructions
Tattoos are permanent and removal is costly and may not be complete
Photo ID
Upload Photo ID
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Signature (Please sign to provide your consent)
Date of Signature
-
Month
-
Day
Year
Date
Submit Consent
Submit Consent
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