Tattoo Consent Form - Minor

Minor - tattoo consent Form

Please mark each box after carefully reading to show that you understand and agree to each provision. All questions must be answered (except preferred name and preferred pronouns are optional).

Feel free to ask any questions regarding this waiver (eyedle.artist@gmail.com).

In consideration of receiving a tattoo from Shanna (eyedle.ink), I agree to the following:

Over Eighteen

I acknowledge that I truthfully represented to the tattoo artist that I am over the age of eighteen (18) years old and that the following information is true and correct.

Not Under the Influence

I am not under the influence of alcohol or drugs. 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.

My Choice

I acknowledge that obtaining my tattoo is by my choice alone and I consent to the application of the tattoo and to the action or conduct of the tattoo artist reasonably necessary to perform the tattoo procedure.

Tattooing Is A Process

I understand and accept that tattooing is a process, sometimes requiring multiple applications of color/pigment to achieve desirable results and that 100% success cannot be guaranteed. I understand that this procedure will fade and this fading can alter the original pigment color and that this may determine it is time for a touch up visit.

Tattoo Will Fade

I realize that 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, the colors and the clarity of my tattoo will fade due to unprotected exposure to the sun and the naturally occurring dispersion of pigment under the skin.

Responsible for Text

I acknowledge that I am responsible for the exact spelling of any text/lettering that I choose to have tattooed.

Tattoo is Permanent

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.

Accept the Risks

I acknowledge it is not reasonably possible for the tattoo artist to determine whether I might have an allergic reaction to the pigments, products, or processes used in my tattoo, and I agree to accept the risk that such a reaction is possible. I am aware that if an infection occurs after I have received a tattoo, to consult with my physician or an emergency room immediately.

Infection 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, will be done at my own expense.

Consulted with Physician

I acknowledge that any blood thinning medications and medical conditions such as but not limited to cancer, diabetes, HIV, AIDS, other communicable diseases, epilepsy, Autoimmune disease or compromised immune system shall increase the risks associated with the tattoo procedure, and I have consulted with my physician prior to proceeding with the tattoo.

Not Pregnant or Nursing

I am not pregnant or nursing.

Hold Harmless

I agree to release and forever discharge and hold harmless the tattoo artist, Shanna (eyedle.ink), from any and all claims, damages, and legal actions arising from or connected to in any way with my tattoo and of the procedures and conduct used to apply my tattoo.

Reimburse Legal Fees

I agree to reimburse any attorney fees and costs incurred in any legal action I bring against the tattoo artist and in which either the artist or the tattoo studio is the prevailing party.

No Refund

I agree that there is a No Refund policy on tattoos and/or retail sales and I will not ask for a refund for any reason whatsoever.

Photographs (choose one)

Yes, I release the right to any photographs taken of me and the tattoo and give consent to their reproduction in print or electronic form. Yes, I release the right to any photographs taken of me and the tattoo, but DO NOT give consent to their reproduction in print or electronic form. No, I do NOT release the right to any photographs taken of me and the tattoo.

I acknowledge by filling out and signing this form that I have been given the full opportunity to ask any and all questions which I might have about the obtaining of a tattoo from Shanna (eyedle.ink), that all of my questions have been answered to my full satisfaction, and that I specifically acknowledge I have been advised of and understand the risks associated with the tattoo procedure. I hereby declare that I have read the agreement, I understand it, and I agree to be bound by it.

Signature: Type your full name in the box below.

Digital Signature

Today's Date

Personal Information

Full Name

Birth Date

Preferred Name

Preferred Pronouns

Address

City

State

Zip

Phone

Drivers License Number

Please take a clear photo of your driver’s license or other government-issued ID and attach it below:

License Photo

Emergency Contact Name

Emergency Contact Phone

EYEDLE INK

Minor - tattoo consent Form

Personal Information

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