Thompson Tattoo Consent Form

Thompson Tattoo Consent Form
Name *

First Name Last Name
Do you have an appointment date scheduled? *

Yes No
Have you paid your deposit? *

Yes No
Sorry!

This form is for those who already have an appointment on our schedule.

If you have not paid your deposit, you do not have an appointment!

Be sure to pay your deposit to secure your spot and then fill out this form before your appointment date.

Please go back to thompsontattoo.com and submit a form to get on the schedule.

Identification

Please fill out the form with the accurate information for the person getting tattooed.
Phone Number *
Please enter a valid phone number.
Email *
example@example.com
Gender *

Female Male Private
Address (Use the same address on your form of ID) *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Date of Birth *

Month Day Year
Date
Are you under the age of 18? *

Yes No
If you are under the age of 18 please attach the following forms of Identification below...

1. A form of ID that includes...
- Your picture
- Your date of birth
- Your first and last name
2. Your Parent/Legal Guardians form of Identification that includes...
- Their picture
- Their date of birth
- Their first and last name (If last names is different please also include 3)
3. If the last name on your parents ID does not match yours then please also include...
- Birth Certificate (If legal Guardian is not your biological parent please include 4)
4. If your Parent/ Legal Guardian is not your biological parent then please also include...
- Court order/ legal documentation of proof of guardianship.
Your Parent/ Legal Guardian must be present on your appointment date for in person verification of this form. To avoid a reschedule, please bring all forms of Identification attached to this form to your appointment as well.
ID Type (Ex. Driver, Passport, State, etc.) *
Please upload a clear photo of your ID (Ex. Driver’s License or passport). *

Cancel of
Emergency Contact Name *

First Name Last Name
Emergency Contact Phone Number *
Please enter a valid phone number.

Appointment Details
Appointment Date *

Month Day Year
Date
Who is your artist? *

Scotty Thompson Dre Thompson
Brief Tattoo Description (Ex. Skull and Rose, Black & Grey) *
Body Location (Right Forearm & Left Ankle) *

Legal Clauses

Please read & Initial the following. If you are under the age of 18 we will need both initials from you and your legal guardian. (Ex. John smith ((Minor)), Karen Smith ((Parent)) enter ((JS, KS)) in the fields below.)
I have truthfully represented to Thompson Tattoo that i am over 18 years of age or have permission from my legal guardian to get this tattoo. *
I acknowledge that it is not reasonably possible for my artist to determine whether i might have an allergic reaction to the dyes, pigments, or processes used in my tattoo, and agree to accept the risk that such a reaction is possible. *
I acknowledge that I have advised my tattoo artist of any conditions that may affect the healing of this tattoo. I do not have medical or skin conditions such as but not limited to: Acne, scarring (keloid), Eczema, psoriasis, freckles, moles, or sunburn in the area to be tattoo that may interfere with said tattoo. If i have any type of infection or rash anywhere on my body, i will advise the tattooer and accept potential risk that may occur if any skin conditions such as the ones stated are applicable if i chose to go forward with my tattoo. *
I am not pregnant or nursing. *
I am not under the influence of alcohol or drugs. *
I acknowledge that infection is always possible as a result of obtaining a tattoo, particularly in the event that i do not take proper cared of my tattoo. I have read through the aftercare instructions on Thompson Tattoo Company’s website and I agree to follow them while my tattoo is healing. I agree that any touch-up work needed, due to my own negligence or conditions, will be done at my own expense. This includes sun and ultraviolet frequency damage. *
I acknowledge that a tattoo is a permanent change to my appearance and that no representations have been made to me as to the ability to later change or remove my tattoo. To my Knowledge, I do not have physical, mental, or medical impairment or disability which might affect my well being as a direct or indirect result of my decision to have a tattoo. *
I acknowledge that if my tattoo is a symbol, or something written in a language other than English, the tattoo artist and the owner of the business are not responsible for what it may or may not mean. *
I acknowledge that if my tattoo includes text that i am responsible for the correct spelling, grammar, and punctuation. I have proofed the text before it is applied as a tattoo. *
I acknowledge that variations in color and design may exist between any tattoo as selected by me and as ultimately applied to my body. I understand that if my skin color is dark, the colors will not appear as bright as they do on light skin. *
I acknowledge the decision for obtaining my tattoo is my own free will and choice. I consent to the location of the tattoo and the performance of the tattoo procedure. *
I acknowledge and agree to following any and all instructions provided to me regarding the maintenance of a sanitary environment while i am being tattooed. *
I agree that the tattoo design is correctly drawn to my specifications and i agree to allow for artist interpretation of the image. *
I agree to IMMEDIATELY notify the artist if i feel lightheaded, dizzy and/ or faint before, during, or after the procedure. Failure to do so releases Thompson Tattoo Company and my tattoo artist of all responsibility. *
My Signature *

Clear
Parent/ Legal Guardian’s Signature (By signing I agree that i have seen my child’s design and approve the size, design, and placement of the tattoo and also agree with all information provided in this form.)

Clear
Should be Empty:

Thompson Tattoo Consent Form

Identification

Appointment Details

Health

Allergies

Diseases/ Conditions

Medications

Legal Clauses