.
GOT... INK...
{ IT HURTS FOR A REASON }
{ ITS FOREVER }
MEDICAL HISTORY AND RELEASE FORM FOR CONSENT TO TATTOO
Please check any conditions listed below that apply to you / or your child :
_____________________________________________________________________________________________
[____________________________________________________________________________________________]
Diabetes [_] Heart Condition [_] Faint or Dizzy [_] Epilepsy [_] Infections [_] Pregnant/ Nursing [_]
Skin Conditions [_] Hepatitis [_] Blood Thinners [_] Eczema [_] T.B. [_] Asthma [_]
H.I.V. [_] Common Cold [_] Drunk [_] Insane [_] Smoker [_] Ready To Pass Out [_]
_____________________________________________________________________________________________
[____________________________________________________________________________________________]
How long has it been since you last ate?
____________________________________________________________________
Do you have any allergies?
______________________________________________________________________________
Are there any other known MEDICAL or SKIN CONDITIONS that will affect you being TATTOOed?
_______________________________________________________________________________________
I HAVE READ AND UNDERSTOOD AND AGREE TO THE FOLLOWING:
... I hereby certify that to the best of my knowledge this information is correct.
... All Questions have been answered to my satisfaction.
... I understand that the said TATTOO is PERMANENT.
... This is to certify that I am at LEAST 18 YEARS OF AGE or with PARENT / GUARDIAN .
... I am not under the influence of ALCOHOL OR DRUGS and am voluntarily submitting to be TATTOOed by GOT...INK... Custom TATTOO without duress or coercion.
... I understand there is a possibility of an allergic reaction.
... I understand there is a possibility of an infection.
... I agree to follow all instructions concerning the care of my TATTOO, and that any touch-ups needed due to my own negligence will be done at my own expense.
... Variations in color and design may exist between the TATTOO art I have selected and the actual TATTOO when it is applied to my body. I also understand that over time, colors and the clarity of the TATTOO will fade due to unprotected exposure to the sun and the naturally occurring dispersion of pigment under the skin.
... I understand that there is a chance I might feel lightheaded, dizzy during or after being TATTOOed.
... I understand that this will hurt, and or cause discomfort while being TATTOOed.
... I agree to immediately notify the artist in the event I feel lightheaded, dizzy and/or faint before, during or after the procedure. Failure to do so releases GOT...INK... Custom TATTOO and ARTISTS of all responsibility.
... I will listen to the ARTISTS after care instruction for the TATTOO and follow them as needed.
... I agree that the ARTIST has given me the full opportunity to ask any and all questions about the application of my TATTOO and all my questions have been answered to my total satisfaction.
... I agree and understand that this is a hobby and practice for the ARTIST only, ANY MONEY exchanged are
for supplies for TATTOO received only.
... I hereby release GOT...INK... Custom TATTOO and ARTIST of all responsibility and from all liability whatsoever for personal injury or otherwise for the said TATTOO given.
... [______] ( Please Initial ) I release all rights to any photographs taken of me and/or the TATTOO and give consent in advance to their reproduction in print or electronic form.
... I hereby declare that I am of legal age ( and have provided valid proof of age ) and am competent to sign this agreement or, if not, that my parent or legal guardian ONLY shall sign on my behalf, and that my parent or legal guardian is in complete understanding and concurrence with this agreement.
By signing this release, I agree to all clauses above ( except photo release if not initialed )
Print Full Name_____________________________________________
Signature_________________________________________Date____________________________
Address______________________________________City___________ State_____ Zip_________
Phone___________________EMAIL Address_______________________________________
DOB__________________ Age____________ Sex_________________
PARENT / GUARDIAN____________________________________________
GOT... INK...
{ IT HURTS FOR A REASON }
{ ITS FOREVER }
MEDICAL HISTORY AND RELEASE FORM FOR CONSENT TO TATTOO
Please check any conditions listed below that apply to you / or your child :
_____________________________________________________________________________________________
[____________________________________________________________________________________________]
Diabetes [_] Heart Condition [_] Faint or Dizzy [_] Epilepsy [_] Infections [_] Pregnant/ Nursing [_]
Skin Conditions [_] Hepatitis [_] Blood Thinners [_] Eczema [_] T.B. [_] Asthma [_]
H.I.V. [_] Common Cold [_] Drunk [_] Insane [_] Smoker [_] Ready To Pass Out [_]
_____________________________________________________________________________________________
[____________________________________________________________________________________________]
How long has it been since you last ate?
____________________________________________________________________
Do you have any allergies?
______________________________________________________________________________
Are there any other known MEDICAL or SKIN CONDITIONS that will affect you being TATTOOed?
_______________________________________________________________________________________
I HAVE READ AND UNDERSTOOD AND AGREE TO THE FOLLOWING:
... I hereby certify that to the best of my knowledge this information is correct.
... All Questions have been answered to my satisfaction.
... I understand that the said TATTOO is PERMANENT.
... This is to certify that I am at LEAST 18 YEARS OF AGE or with PARENT / GUARDIAN .
... I am not under the influence of ALCOHOL OR DRUGS and am voluntarily submitting to be TATTOOed by GOT...INK... Custom TATTOO without duress or coercion.
... I understand there is a possibility of an allergic reaction.
... I understand there is a possibility of an infection.
... I agree to follow all instructions concerning the care of my TATTOO, and that any touch-ups needed due to my own negligence will be done at my own expense.
... Variations in color and design may exist between the TATTOO art I have selected and the actual TATTOO when it is applied to my body. I also understand that over time, colors and the clarity of the TATTOO will fade due to unprotected exposure to the sun and the naturally occurring dispersion of pigment under the skin.
... I understand that there is a chance I might feel lightheaded, dizzy during or after being TATTOOed.
... I understand that this will hurt, and or cause discomfort while being TATTOOed.
... I agree to immediately notify the artist in the event I feel lightheaded, dizzy and/or faint before, during or after the procedure. Failure to do so releases GOT...INK... Custom TATTOO and ARTISTS of all responsibility.
... I will listen to the ARTISTS after care instruction for the TATTOO and follow them as needed.
... I agree that the ARTIST has given me the full opportunity to ask any and all questions about the application of my TATTOO and all my questions have been answered to my total satisfaction.
... I agree and understand that this is a hobby and practice for the ARTIST only, ANY MONEY exchanged are
for supplies for TATTOO received only.
... I hereby release GOT...INK... Custom TATTOO and ARTIST of all responsibility and from all liability whatsoever for personal injury or otherwise for the said TATTOO given.
... [______] ( Please Initial ) I release all rights to any photographs taken of me and/or the TATTOO and give consent in advance to their reproduction in print or electronic form.
... I hereby declare that I am of legal age ( and have provided valid proof of age ) and am competent to sign this agreement or, if not, that my parent or legal guardian ONLY shall sign on my behalf, and that my parent or legal guardian is in complete understanding and concurrence with this agreement.
By signing this release, I agree to all clauses above ( except photo release if not initialed )
Print Full Name_____________________________________________
Signature_________________________________________Date____________________________
Address______________________________________City___________ State_____ Zip_________
Phone___________________EMAIL Address_______________________________________
DOB__________________ Age____________ Sex_________________
PARENT / GUARDIAN____________________________________________
