I acknowledge by signing this agreement that I have been given the full opportunity to ask any and all questions
which I might have about the obtaining of a tattoo and that all of my questions have been answered to my full satisfaction.
I specifically acknowledge I have been advised of the facts and matters set forth below and I agree as follows:
• If I have diabetes, epilepsy, hepatitis, hemophilia, HIV-AIDS, or any other communicable disease, heart condition
or take medicine which thins the blood I have advised my tattooist. I am not pregnant or nursing. I am not
under the influence of alcohol or drugs.
• I do not have medical or skin conditions such as but not limited to: acne, scarring (Keloid), Eczema, psorias
is, rash, infection, lesion, freckles, moles or sunburn in the area to be tattooed that may interfere with said tattoo.
If I have any type of infection, rash, or lesion anywhere on my body, I will advise my tattooist.
• I acknowledge it is not reasonably possible for the representatives and employees of this tattoo shop to determine
whether I might have an allergic reaction to the pigments or processes used in my tattoo, and I agree to
accept the risk that such a reaction is possible.
• I acknowledge that infection is always possible as a result of the obtaining of a tattoo, particularly in the event
that I do not take proper care of my tattoo. I have received aftercare instructions 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 failure to
follow such instructions, will be done at my own expense.
• I realize 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
• I understand that if I have any skin treatments, laser hair removal, plastic surgery or other skin altering procedures,
it may result in adverse changes to my tattoo.
• 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 a 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 I am over the age of eighteen and that I have truthfully represented to my tattooist that the obtaining
of a tattoo is by my choice alone. I consent to the application of the tattoo and to any actions or conduct of
the representatives and employees of the tattoo shop reasonably necessary to perform the tattoo procedure.
• I understand that ______________________________ reserves all rights to use any photos of my piercing or tattoo
taken in ______________________________.
Therefore, I request the Tattooist tattoo my _________________________. I understand this type of tattoo usually takes
_________________ or longer to heal. I hereby release and forever discharge and hold harmless __________________,
the Tattooist and all affiliates, Owners, Managers and Employees from any and all claims, damages or legal actions
arising from or connected in any way with my tattoo, or the procedure and conduct used in my performing my
tattoo, to the fullest extent allowed by the law.
By signing below, I, _______________ , or their legal guardian, agree that I have read the Tattoo
release form provided by ________________ and agree to its terms.