Tattoo & Piercing Consent Form
Complete this consent before your appointment—no ID uploads required.
Client Details
Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
WhatsApp / Mobile Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Appointment
Service Selection
*
Please Select
Tattoo
Cover-Up
Touch-Up
Piercing
Tattoo & Piercing
Appointment Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Studio / Location
*
Please Select
East Studio
South Studio
Event/Other
Artist / Piercer
Age and Guardian Consent
Is the client 18 years old or over?
*
Yes
No
Minor consent notice
For clients under 18, only a parent, legal guardian, or competent person may sign. The minor cannot self-consent.
Before the appointment, the parent, legal guardian, or competent person must send a clear copy/photo of the relevant ID and proof of guardianship or authority via Tattoos By Charlene WhatsApp, and present the original/current ID on the appointment day. Do not upload ID documents to Jotform.
Minor’s full name
*
First Name
Last Name
Parent / legal guardian full name
*
First Name
Last Name
Relationship to minor
*
Guardian WhatsApp / mobile number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Guardian email address
*
example@example.com
Are you authorised to consent on behalf of the minor?
*
Yes
No
Minor verification acknowledgement
*
I understand that minor verification documents must be sent via WhatsApp before the appointment and not uploaded to Jotform.
I understand the minor cannot self-consent and a parent/legal guardian/competent person must sign where applicable.
Safety Screening
Do you have any safety concerns that may affect your tattoo or piercing appointment?
*
No
Yes
If yes, please provide details
Which of the following apply to you?
Allergies or sensitivities
Previous reaction to tattoo or piercing products or jewellery
Current illness, infection, or skin irritation at the treatment area
Condition or medication that may affect bleeding or healing
History of keloid or excessive scarring
Pregnant or breastfeeding
Other relevant safety information
Procedure Acknowledgement
I confirm that the information provided is truthful and complete, and that my date of birth is accurate.
*
I confirm that the information provided is truthful and complete, and that my date of birth is accurate.
Terms, policies and service consent
By signing, I confirm that I have read and agree to the applicable Tattoos By Charlene website terms and policies.
I understand that false information or a false date of birth may result in refusal or cancellation.
Studio Policies
POPIA notice
Tattoos By Charlene collects only information reasonably necessary for services, consent, safety, age or guardian verification, and records. Reasonable security measures are taken. Where a minor is involved, verification documents sent via WhatsApp are used only for verification.
I confirm that I have authority to consent where required, will send the required verification documents via WhatsApp, will present the original/current identification on the appointment day, and understand the appointment may be refused or postponed if verification is not satisfactory.
*
I confirm that I have authority to consent where required, will send the required verification documents via WhatsApp, will present the original/current identification on the appointment day, and understand the appointment may be refused or postponed if verification is not satisfactory.
Final Declaration
Full name of person signing
*
First Name
Last Name
Electronic signature
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Submit
Should be Empty: