Consent Form – High Vision Gallery

CONSENT TO APPLICATION OF TATTOO

RELEASE AND WAIVER ALL CLAIMS

Name: DOB: Address: Your email: Parental Permission Signature, (if):

Tattoo Description: Tattoo Placement:

I acknowledge by signing this form, that I have been given the full opportunity to ask any and all questions which I might have about obtaining a tattoo and that all 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:

I acknowledge I am not pregnant or nursing.I am the person on the legal ID presented as proof I am at least 18 years of age.I am free of any communicable disease such as but not limited to: diabetes, epilepsy, hepatitis, hemophilia, HIV-AIDS or any other. If I have any type of disease I will advise my tattooer.I am not under the influence of alcohol or drugs and I am voluntarily submitting myself to get a tattoo without duress to coercion.I understand getting a tattoo is a permanent change to my body and can only be removed by a surgical procedure.I have informed the artist of any allergies or skin sensitivities that I may have, any medications I am taking, and any medical treatments I am currently receiving.I do not have any medical or skin conditions such as but not limited to: acne, scarring (keloids), eczema, psoriasis, freckles, moles or sunburn in the area to be tattooed that may interfere with said tattoo. If I have any type of infection or rash anywhere on my body, I will advise my tattooer.I acknowledge that infection is always possible as a result of obtaining a tattoo, particularly in the event that I do not take proper care of my tattoo.I have received aftercare suggestions and agree to care for my tattoo to the best of my ability.I authorized to take photos and videos of my tattoo and the process and I agree that content will be posting on social media.I realize that variations in color and design my exist between any tattoo selected by me and as ultimately applied to my body. I understand that a tattoo is a work of art and minor imperfections are likely.I also understand that color may varied according to my skin tone.I consent to the application of the tattoo and to any actions or conduct of the representatives and employees of the tattoo shop reasonable necessary to perform the tattoo procedure. Signature (Required):

Date:

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CONSENT TO APPLICATION OF TATTOO

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