Love Bites Consent Form

First and Last Name

Pronouns

Today's Date

Date of Birth

Emergency Contact Name

Emergency Contact Phone Number

I specifically acknowledge I have been advised of the facts and matters set forth below and I agree as follows:

I am not pregnant or nursing

I am not under the influence of alcohol or drugs

I acknowledge I am over the age of eighteen and that I have truthfully represented to my tattoo artist that the obtaining of a tattoo is by my choice alone.

If I have any medical or skin conditions in the area to be tattooed that may interfere with the tattoo, or any type of infection or rash anywhere on my body, I will advise my tattoo artist

I understand that if I have any skin treatments, laser hair removal, cosmetic surgery or other skin altering procedures, it may result in changes to my tattoo.

I acknowledge that a tattoo is a permanent change to my appearance and do not hold my tattooer liable for or of the ability to later change or remove my tattoo.

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 agree to follow aftercare instructions provided by my artist while my tattoo is healing.

I acknowledge it is not possible for this 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

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 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 the finished tattoo may vary somewhat in appearance, color and/or design from the paper or other drawing or photographic image, which the tattoo design is based on.

I agree to release and discharge my artist from any and all claims, damages, or legal actions arising from or connected to my tattoo and the procedure used in the application of my tattoo.

I consent to the application of the tattoo from Ash, and agree to release and forever discharge them/hold them harmless from any and all claims, damages, or legal actions arising from or connected in any way with my tattoo.My tattoo artist and I recognize that I may revoke this consent at any time before or during the tattoo procedure.

Do you have any communicable diseases? (HBV, HCV, HIV, AIDS, etc.)

Yes

Are you prone to fainting?

• Do you have any known allergies? (medicines, pigments, latex, antiseptics) If yes, please list:

By signing here I acknowledge that I have read the above acknowledgement and agree to it's terms

Signature

Please upload a photo of your ID

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