Tattoo Waiver

TATtunes custom tattoos

MEDICAL HISTORY and TATTOO CONSENT AND RELEASE FORM 

Please check any conditions listed below that apply to you.

DiabetesHIV / AIDSHeart ConditionFaint or DizzyEpilepsyHemophilia Eczema/PsoriasisInfectionsT.B.Scarring/KeloidingHerpesAsthmaHepatitisPregnantNursingBlood Thinners

FILL OUT COMPLETELY (N/A IS NOT AN ANSWER):

How long has it been since you last ate? __________________________________________________________

Do you have any allergies? ____________________________________________________________________

List all medications you are currently taking. _______________________________________________________________

Are there any other known MEDICAL CONDITIONS or CONTAGIOUS DISEASES that may affect your TATTOO procedure? ________________________________________________________________________________I hereby certify that to the best of my knowledge this information is correct.

All Questions have been answered to my satisfaction.

I agree the said TATTOO is correctly drawn to my specifications.

I understand that the said TATTOO is PERMANENT.

This is to certify that I am at LEAST 18 YEARS OF AGE.

I am not under the influence of ALCOHOL OR DRUGS.

I understand there is a possibility of an allergic reaction.

I understand there is a possibility of an infection.

I agree to allow for ARTIST INTERPRETATION.

I agree to follow all instructions concerning the care of my TATTOO.

I understand that there is a chance I might feel lightheaded, dizzy and/or faint due to my decision to receive a TATTOO.

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 BEST TATTOOS, INC. and ARTISTS of all responsibility.

I hereby release BEST TATTOOS, INC. and ARTISTS of all responsibility for the said TATTOO.

NO REFUNDS.

CUSTOMER'S INFORMATION (FILL OUT COMPLETELY):

Customer Printed Name: ________________________________________

Customer Signature / Parental Signature____________________________ Date__________ Ph# ___________

Address______________________________________ City______________ State____ Zip_________

Driver's License #______________________________ DOB__________________ Age ___________

Race _______________ Sex _______________

Design__________________________ Placement________________________ Artist______________

Artist Signature ______________________

Emergency Contact ______________________________________________ Ph# _________________

Address______________________________________ City______________ State____ Zip_________

If under 18, child and parent(s) signatures need to be done in presence of a notary. All blanks must be filled in. Parent(s) must be present and proper identification must be presented prior to service.

I give my permission for my child to receive the said TATTOO.

Parental Signature_____________________________________ Date______ DL#________________________

Minor Signature______________________________________ Date______ DL#________________________

Notary Statement

Sworn and Scribed before me on this ______ Day of _________________ 200___

Notary____________________________________ Seal: