Tattoo Consent and Release Form

This consent form is to move forward with receiving a permanent tattoo, performed at Scaredy Rat Tattoo. To abide North Carolina laws, I understand that my identification will be checked prior to the appointment.

The information given (such as a birth name, address, gender, phone number, email) will never be shared.

Legal Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Date of Birth

Preferred Name

Preferred Pronouns

Phone

Who is doing your tattoo today?

Lauren (@Inkmachinebarbie)
Sam (@Ravnlandtattoos)

Location of Tattoo

Select all that apply.

Do you have any allergies?

Yes
No

Such as, but not exclusive to: Latex, Medical Adhesives, Coconuts, or Previous Tattoo/ Ink Reactions.

If yes, please explain allergies.

Are you aware of any medical conditions that are related to the tattoo process?

Yes
No

Such as, but not exclusive to, jaundice, heart conditions, fainting spells, diabetes, hemophilia, HIV, Hepatitis, epilepsy, etc.

If yes, please explain medical condition(s)

Do you have any upcoming plans or vacations that might effect the tattoos healing?

Yes
No

Ocean, lakes, sunburns, etc. can all ruin a tattoo and/or leave you at great risk of other complications. If yes, I acknowledge any risks and will take precautions to the best of my ability (such as staying out of the water or replanning the trip.)

Have you eaten or had a drink before the appointment?

Yes
No

Acknowledgments and Consent

I acknowledge that I am voluntarily obtaining a tattoo from Scaredy Rat Tattoo and that the tattoo will be permanent.
I confirm that I am the age of 18 (or over) at the time that I am reading this paperwork.
I understand that there are risks associated with getting a tattoo, including but not limited to, infection, allergic reactions, and scarring. In that chance that this does occur, I understand medical attention should be first step to avoid complications.
I confirm that I do not have any medical conditions that may interfere with the healing process or that may be aggravated by the tattoo process. If I do, I have consulted my physician about my intentions to be tattooed.
I agree to follow the aftercare instructions provided by Scaredy Rat Tattoo to ensure proper healing of the tattoo.
I release Scaredy Rat Tattoo, Lauren and/or Sam from any and all liability for any adverse reactions or complications that may arise as a result of the tattoo procedure. The artist and Scaredy Rat Tattoo are not liable for any future coverups or removal.
I acknowledge I am not pregnant or under the influence of alcohol or drugs at this time.

Process/Design Confirmation

I acknowledge that Scaredy Rat Tattooexclusively uses single use, disposable products in this establishment.
I have checked and approved the drawing/design and stencil placement, prior to the tattoos application.
I understand that I can ask the stencil to be moved or resized in order to meet my expectations.
If there are letters, numbers, words (lyrics, names, dates, times, etc.) I have given the artist the correct information and have double checked the stencil for accuracy.

I certify under penalty of perjury that the above information is correct and true,

Yes

Signature of Client

Please type your full name as proof of signature.

Date / Time

Date

Time

Emergency Contact Information

Emergency Contact Relationship

Emergency Contact Phone Number

How did you hear about us?