Consent FORM Name * First Name Last Name Email * Phone * (###) ### #### Date of birth MM DD YYYY Your Artist * Michael Kyle Chris Jimmy Josh Ethan Zoe Elena Corinna Guest Artist Tattoo Date (Today's Date) * MM DD YYYY Are you 18 years of age or older? * We do not tattoo minors under any circumstances Yes, I have a vaild ID on my person No, I am not 18 and cannot be tattooed Are you pregnant or breastfeeding? * We will not tattoo clients that are pregnant or breastfeeding NO YES I am aware of the inherent risks associated with getting a tattoo. I fully understand that these risks, known and unknown, can lead to injury including but not limited to: infection, scarring, difficulties in the detection of melanoma and allergic reactions to tattoo pigment and/or soap. Knowing the potential risks associated with getting a tattoo I wish to proceed with the tattoo procedure and application and freely accept and expressly assume any and all risks that may arise from tattooing. * Yes, tattoo me! No, I have decided to not get tattooed I WAIVE AND RELEASE to the fullest extent permitted by law any person of Seven Cities Tattoo Co. from all liability whatsoever, including but not limited to, any and all claims or causes of action that I, my estate, heirs, executors or assigns may have for personal injury or otherwise, including any direct and/or consequential damages, which result or arise from the procedure and application of my tattoo, whether caused by the negligence or fault of either the Tattoo Studio, or otherwise. * Yes, tattoo me! No, getting tattooed is too scary I understand Seven Cities Tattoo Co. is a CASH ONLY studio. I understand that I am required by law to pay the artist in cash (or agreed alternative payment route) at the end of this tattoo session. * Yes, cash money! Yes, again, non-negotiable I will disclose with my artist any medical information that might affect the tattooing process including, but not limited to: allergies, medications, diabetes, epilepsy, hemophilia, heart conditions, skin conditions, cancers, blood infections (HIV and other STI's) ect. * YES Getting personal... I decided to not be tattooed Thank you! Plese present your ID to the front counter.
