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Skull Gunk Tattoo Consent Form

This information is collected as required by Washington State Licensing. It will remain confidential, and isn’t used for anything aside from record keeping.

Email and/or phone number, Instagram

Upload pic of ID

Acceptable forms of ID include: Drivers License, passport, military ID, State/county issued ID, etc.
Alternatively, you can fill out a paper consent form and have me photocopy your ID in person. 
If you’re doing the paper form, upload a random image below.

Full, legal name

Preferred name (if different)

Date of birth

Have you been vaccinated against covid?

A
B

Photo of vaccine records. 
If no current records, skip.

Covid symptoms: Fever/chills, cough, shortness of breath/difficulty breathing, fatigue, muscle/body aches, headache, new loss of taste/smell, sore throat, congestion/runny nose, nausea/vomiting, diarrhea.

Have you had any covid symptoms OR a positive covid test in the past 14 days?

A
B

Within the past 14 days, have you spent significant time with anyone who has covid or was exhibiting covid-like symptoms?

A
B
By signing this agreement, I specifically acknowledge I have been advised of the facts and matters set forth below and agree as follows:

~If I have diabetes, epilepsy, hepatitis, hemophilia, HIV-AIDS, or any other communicable disease, heart condition, or take anticoagulants or medicine which thins the blood (including aspirin or ibuprofen), I have advised my tattooer.
~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, psoriasis, moles or sunburn in the area to be tattooed that may interfere with said tattoo. If I do have one of these conditions, I have advised my tattooer.
-I acknowledge it is not reasonably possible for the tattoo artist 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. 
-If I have known allergies or sensitivities, I have informed my tattoo artist.
-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 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 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 (including a handpoked tattoo) is a permanent change to my appearance and do not hold my tattooer liable for /of the ability to later change or remove my tattoo.
-I acknowledge I am over the age of eighteen and that I have truthfully represented to my tattooer that the obtaining of a tattoo is by my choice alone.
-I fully understand the tattoo artist does not act as a medical professional. Any suggestions made to me are NOT to be construed as or substituted for advice from a medical professional.
-I agree to release and discharge my artist from any claims, damages, or legal actions arising from or connected to my tattoo and the procedure used in the application of my tattoo.
-I confirm that within the last 14 days, I have not tested positive for Covid, nor have I presented with symptoms of Covid, nor have I knowingly come into contact with any persons that have tested positive for Covid.
-I consent to the application of the tattoo. My tattoo artist and I recognize that I may revoke this consent at any time before or during the tattoo procedure.
Please provide your signature once you have read, understand, and accept the terms of the tattoo process.
Signature

Photo use permission:

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