Consent & Release Form Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Texts OK? Yes No Email * Date of birth * MM DD YYYY I am over 18 years of age * I acknowledge that a tattoo is a permanent change to my appearance. I do not have any medical condition (including pregnancy) that would be complicated by receiving or healing a tattoo. If necessary I have consulted with my doctor to be sure it is safe for me to receive a tattoo. If you are under a doctor's care, please list the reasons: I am free of all communicable diseases. I acknowledge that it is not possible for anyone at Tattoo Garden to determine whether I may have an allergic reaction to the dyes, pigments, or procedures used in the application of my tattoo and agree to accept the risk that such a reaction is possible. I am aware that infection is always possible at any time during the healing process, I recognize the absolute necessity in taking proper care of my tattoo and have firm understanding of what that entails/ I am NOT under the influence of any drug or alcohol and have made the decision to obtain a tattoo on my own. I agree to release and forever hold harmless TATTOO GARDEN and all of it's agents from any claims, damages, or legal action arising from my tattoo or the procedure and conduct used to apply it. I agree to give unrestricted right and permission to copyright and use, re-use, publish, and republish photographs, portraits, or pictures of me or in which I may be included intact or in part, composite, or distorted in character or form, without restriction to changes or transformations in conjunction with my own or a fictitious name, or reproduction hereof in color or otherwise, made through any and all media now or hereafter known for illustration, art, promotion, advertising, trade, or any other purpose whatsoever, to TATTOO GARDEN. I acknowledge by signing this document that I have been given a full opportunity to ask any questions which I might have about obtaining a tattoo from TATTOO GARDEN. I specifically recognize and have indicated to show agreement with the items listed above. * Todays Date * MM DD YYYY Thank you! You will be asked to sign this in person upon entering Tattoo Garden to acquire your tattoo.
