Name *

First Name

Last Name

I certify and acknowledge that I am 18+ *

Yes

Phone *

Country

(###)

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I acknowledge that I am not under the influence of alcohol or drugs *

Yes

I acknowledge that I am not pregnant or nursing. I acknowledge that I do not have diabetes, hemophilia, a heart condition, hepatitis, HIV/AIDS, or any other communicable diseases, nor conditions affecting the blood, nor do I take blood thinning medication. I do not have any mental impairment that may affect my judgement in getting the tattoo. I am not currently taking antibiotics (if you are, PLEASE notify your artist before completing this form!) *

Yes

I acknowledge I have looked over my design, checked the spelling if applicable, and give my full consent for the application of my tattoo and the final outcome and placement. *

Yes

I give consent to allow my tattoo to be photographed and to possibly be shared on social media and/or the artists portfolio. *

Notify the artist if you prefer not to.

Yes

No, I would prefer not

I agree to tell my artist about any known tattoo allergies I may have, and I acknowledge that the studio does not have any way of identifying prior to the tattoo if I am allergic to the elements or ingredients that will be used for my tattoo. *

I have no known allergies and acknowledge all stated above

I have a known allergy that I will notify the artist about (common example, latex) that the artist will reasonably accommodate to the best of their abilities, and I acknowledge all stated above

I acknowledge that I have been told by my artist and also read The Vintique Bazaar's aftercare instructions and have a responsibility to care for my tattoo properly by following the instructions given. *

Aftercare instructions are also available for access on The Vintique Bazaar's website.

Yes

I understand that if I do not follow the tattoo aftercare instructions given to me, this may result in an infection. I accept full responsibility for taking care of my tattoo. *

Yes

I hereby certify that all answers provided are true, correct, and that I consent to the artist to apply this tattoo. I am aware of all risks associated with getting a tattoo, I have notified my artist of any pre-existing health conditions/medications, and/or latex/ink allergies, and I have been fully informed about the risks of tattooing including but not limited to: infection, scarring, difficulties in detecting melanoma, and allergic reactions to tattoo pigment, latex gloves, and antibiotics. I hereby consent to the application of the tattoo. *

I consent

Todays Date *

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DD

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