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Halloween Flash Event
Sweet treats and spooky tattoos!
Tattoo Consent Form
Client Information
Name
*
First Name
Last Name
Age
*
Birth Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Phone Number
*
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Pre-Procedure Questionnaire
FEMALE ONLY: Are you pregnant or nursing?
*
Yes
No
Do you have a communicable disease?
*
Yes
No
Please tell about your medical history (e.g. DIabetes, Cardiovascular Disease, Epilepsy, Blood-related disease etc.)
If yes, please identify the condition
Acknowledgment and Waiver
*
I understand that this procedure is a permanent change to my skin and body
*
I acknowledge that the Tattoo Shop does not offer refund
*
I agree that the artists do not have a way of identifying if I am allergic to the metals or processes that will be used for my tattoo or piercing
*
I understand that I need to take care of the tattoo or piercing by following the instructions given to me. Failure to do so, may result in an infection
*
I understand and hold harmless Gremlins Tattoo Lounge and its artists against any claims, expenses, damages, and liabilities
*
I confirm that the information I provided in this document is accurate and true
Signed Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Client Signature
*
Back
Next
Which flash tattoo are you looking to get?! Each one has a number (max of 2)
*
K1
K2
K3
K4
K5
K6
K7
K8
K9
K10
K11
K12
K13
K14
K15
K16
K17
K18
K19
K20
K21
K22
K23
K24
M1
M2
M3
M4
M5
M6
M7
M8
M9
M10
M11
M12
M13
M14
M15
M16
M17
M18
M19
M20
M21
M22
M23
M24
M25
M26
M27
M28
M29
M30
M31
M32
M33
E1
E2
E3
E4
E5
E6
E7
E8
E9
E10
E11
E12
T1
T2
T3
T4
T5
T6
T7
T8
T9
T10
T11
T12
T13
T14
T15
T16
T17
T18
T19
T20
T21
C1
C2
C3
C4
C5
C6
C7
C8
C9
C10
K=Kirsten (K1-K24), M=Marissa (M1-M33), E=Erick (E1-E12), T=Tatah (T1-T21), C=Chris (C1-C10)
Preferred time slot
10am-Noon
Noon-2pm
2pm-4pm
4pm-6pm
6pm-8pm
Submit
Submit
Should be Empty: