Ink Kingdom 876 Consent Form

Ink Kingdom 876 Consent Form
Please fill out this form to provide your consent for receiving a tattoo &/or piercing at Ink Kingdom 876. Your safety and understanding of the procedure are our top priorities.
Thank you for your cooperation.

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Client's Information

AGE *

Birth Date *

City *

Parish *

Email *

Phone Number *

Are you under the influence of drugs or alcohol? *

Yes No

FEMALE ONLY : Are you pregnant or nursing? *

Yes No

Do you have a communicable disease? *

Yes No

Do you have any medical conditions? *

Yes No

Skin conditions (e.g. Rashes, eczema, infection, psoriasis, freckles, etc.) *

If yes, please identify the condition

Please tell about your medical history(e.g. HIV,diabetes, cardiovascular disease, epilepsy, blood-related disease etc.) *

If yes, please identify the condition

What service are you interested in receiving at Ink Kingdom 876 ? *

Tattoo Piercing Both

How confident are you in the cleanliness and sterilization practices of our studio? (1 being the least confident, 10 being most confident? *

Acknowledgment & Waiver

Acknowledgement & Waiver *

I understand that this procedure is a permanent change to my skin and body. i allow my tattoo to be photographed and be used for Ink Kingdom 876 portfolio showcased. i acknowledge that Ink Kingdom 876 does NOT offer refund. i agree that the studio does not have a way of identifying if I am allergic to the elements or ingredients that will be used for my tattoo or piercing

Acknowledgement & Waiver *

I understand that I need to take care of the tattoo &/or piercing by following the instructions given to me by the body artist.. I understand that I might get an infection if I don't follow the instructions given to me in regards of taking good care of my tattoo &/or piercing. I indemnify and hold harmless the Tattoo Shop against any claims, expenses, damages, and liabilities. I confirm that the information I provided in this document is accurate and true.

Signed Date *

Digital Signature *

SIGN ABOVE BY TYPING YOUR COMPLETE NAME AS SHOWN ON YOUR IDENTIFICATION CARD

Submit