TATTOO ZOO CONSENT FORM

Name (preferred/chosen)*

First NameLast Name

Date of Birth*

Date

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Harassment Policy: I agree with Tattoo Zoo's zero-tolerance policy against harassment, bullying and discrimination.*

I agree

PRONOUN

HeSheThey

Other

I DECLARE: That I am 18 years or older.
I have approved the placement and design of my tattoo. I accept full responsibility for any adverse effects suffered by me as a result of any health conditions or medications, whether disclosed below or not, or as a result of poor aftercare or personal hygiene. I further consent to the display or promotional use of any photographs of my tattoo by Tattoo Zoo.

I fully understand the risk to my person, either through infection or accident. I will not hold The Tattoo Zoo, employees, respective estates, heirs, representatives or agents responsible for any adverse effects suffered by me as a result of such a tattoo.

To ensure your safety and to enable us to provide you with the appropriate care instructions for your tattoo, we ask that you advise us of the following:

1. Any health conditions or medications that may affect your immune system or ability to heal (ie: pregnancy, diabetes, hemophilia, hepatitis, HIV, etc).

2. Any allergies:

3. Any health conditions or medications which may cause loss of consciousness or seizures (ie: epilepsy, heart disease, etc).

4. Extra considerations: Examples: “Fear of needles.” “I’d like to wear my headphones” “Loud noises trigger my flight response.”

5. How did you hear about us?

Signature*

You may be asked to provide Photo I.D.

Tattoo Zoo reserves the right to request a physician’s certificate or to refuse service to anyone for any reason.