TODAYS DATE *

MM

DD

YYYY

NAME *

First Name

Last Name

DATE OF BIRTH *

MM

DD

YYYY

PHONE *

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ADDRESS *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I am of sound mind and not under the influence of drugs or alcohol *

I am

I acknowledge that a PREGNANT PERSON SHOULD NOT receive a tattoo and that I AM NOT PREGNANT *

I confirm I am not pregnant

I acknowledge that I am free of communicable diseases to the best of my knowledge or that I will make my artist aware of any I may have. *

I confirm

I acknowledge that I am aware that if I have acne, freckles, moles, or sunburn in the area to be tattooed that might be agitated by the tattoo process, it may affect the healing and or final appearance of my tattoo *

I confirm

I acknowledge that I will look over my design, check the spelling if applicable, and give my full consent to the application of my tattoo before the artist permanently applies the tattoo. *

I confirm

I acknowledge it is not reasonably possible for my tattoo artist to determine whether I might have an allergic reaction to the dyes, pigments, or processes used in my tattoo and I agree to accept that such risks are possible. *

I confirm

I acknowledge that infection is always possible as a result of obtaining a tattoo, particularly in the event that I do not take proper care of my Tattoo and I have been advised of the signs and symptoms of infection that indicate a need to seek medical care. *

I confirm

I agree to follow all instructions concerning the care of my tattoo, and that any touch-ups needed because of my own negligence will be done at my own expense. *

I confirm

I acknowledge that variations in color and design may exist between any tattoos as selected by me and as ultimately applied to my body. *

I confirm

I acknowledge that tattooing 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 my tattoo. *

I confirm

I acknowledge that the obtaining of my tattoo is my choice alone and I consent to the application of the tattoo and to any actions or conduct of the associates, agents or representatives of Hidden Door Tattoo that are reasonably necessary to perform the tattoo procedure. *

I confirm

I agree to release and forever discharge and forever hold harmless Hidden Door Tattoo and its associates, agents officers and shareholders from any and all claims, damages, or legal actions 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 my tattoo artist, their associates, agents and representatives in the future. *

I confirm

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 confirm

I acknowledge that there is a chance I might feel lightheaded, dizzy during or after being tattooed. I agree to immediately notify the practitioner in the event I feel lightheaded, dizzy and/or faint before, during or after the procedure. *

I confirm

I acknowledge that 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. Having been informed of the potential risks associated with getting a tattoo, I still wish to proceed with tattoo application and I assume any and all risks that may arise from tattooing. *

I confirm