class="sr-only"Your Name Date of Birth Address (Full) Phone Number Placement of Tattoo Artist and Price Do you have allergies to any of the following? Antibiotics:YesNo Soap:YesNo Metals:YesNo Latex:YesNo Alcohol:YesNo Are you currently taking medication?YesNo Medication Type Pregnant:YesNo Have a heart condition:YesNo Skin Condition:YesNo Subject to fainting or dizziness:YesNo High Blood Pressure:YesNo Subject to Rashes:YesNo Diabetic:YesNo Sensitive Skin:YesNo Epileptic:YesNo IV Drug User:YesNo I specifically acknowledge that I have been advised of the facts and matters set forth below and by checking I agree as follows: I acknowledge that it is not reasonably possible for my artist to determine whether I may have an allergic reaction to the dyes, pigments, and or processes used in the application of my tattoo and I accept the risk that reaction may possibly occur I acknowledge that infection is always possible particularly in the event that I do not properly care for my tattoo. I acknowledge receipt of written and verbal instructions advising me of proper care of my tattoo. I realize that variations in color and design may exist between any tattoo represented on paper selected by me and as ultimately applied to my body I acknowledge that a tattoo is considered permanent and can only be removed by a surgical procedure and such removal may result in permanent scarring or disfigurement. I acknowledge that I have truthfully represented to my artist that I am over the age of 18 years, and my parent or legal guardian is signing below because I am a minor. I acknowledge that the obtaining of my tattoo is by my choice alone and I consent to the application of the tattoo. I acknowledge that I am not under the influence of alcohol, drugs and or any other intoxicating substance at the time of the tattoo. I hereby give my artist permission to copyright and/or publish photographic portraits or pictures of me or in which I may be included in whole or in part of reproductions therefore made through any media for art, advertising, or any other lawful purpose whatsoever. I waive any right I have to inspect or approve the finished product of the use to which it may be applied. I acknowledge that by signing this writing that I have been given full opportunity to ask any and all questions I might have about obtaining a tattoo, and that all my questions have been answered to my full and total satisfaction. I agree to release and forever discharge and hold harmless my artists and the studio in which my tattoo was obtained from any and all claims, damages, or legal actions arising from or connected in any way with my tattooer the procedure and conduct used to apply my tattoo or the processing or production of any said pictures. Take a photo of your ID Signature of Client Date of Procedure Signature of Parent/Guardian