*I consent to the collection and retention of the information provided in this form for business, health and safety, and record-keeping purposes only.

*To the fullest extent permitted by law, I release and hold harmless the tattoo artist, studio, owners, employees, and contractors from claims, damages, or liabilities arising from the tattoo procedure, except where caused by gross negligence or willful misconduct.

*I acknowledge by signing this agreement that I have been given the full opportunity to ask any and all questions which I might have about the obtaining of a tattoo and that all of 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 have disclosed to my tattoo artist any medical condition, medication, allergy, skin condition, blood disorder, or other health concern that may affect the tattoo procedure or healing process.

*I acknowledge it is not reasonably possible for the representatives and employees of this tattoo shop to determine whether I might have an allergic reaction to the soap, gloves, ointments, pigments or processes used in my tattoo, and I agree to accept the risk that such a reaction is possible. I have also informed my Artist of any allergies beforehand.

*If I have any infections, blood or skin conditions I have advised my tattooist. I am not pregnant or nursing. I am not under the influence of alcohol or drugs.

*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 or failure to follow such instructions, will be done at my own expense.

*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 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. 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 understand that cover-up tattoos are subject to limitations imposed by the existing tattoo, scar tissue, skin tone, and placement. No guarantee has been made regarding the degree to which the original tattoo can be concealed.

*I acknowledge I am over the age of eighteen and that I have truthfully represented to my tattooist that the obtaining of a tattoo is by my choice alone. I consent to the application of the tattoo and to any actions or conduct of the representatives and employees of the tattoo shop reasonably necessary to perform the tattoo procedure.

*I acknowledge that my tattoo may be photographed/filmed to be used for portfolio, website, advertising, and social media purposes.