Tattoo WaiverPlease wait until the day of your appointment to fill out this form.Have your ID ready for me to check. Legal Name * First Name Last Name Preferred Name Preferred Pronouns Date of Birth * MM DD YYYY I am over the age of 18. Yes CONTACT INFO Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Email COVID & ILLNESS Symptoms * Please indicate if you have experienced any of the following symptoms within the last 14 days. shortness of breath fever cough chills sore throat no symptoms Have you been around anybody with these symptoms in the past 14 days? * Yes No If you answered yes to the previous question, please explain WAIVER I confirm that I am getting this tattoo of my own free will. I know that I can stop the procedure at any time, including right now. * I agree I understand that a tattoo procedure will permanently change my appearance. * I understand I agree to release the artist, the studio, and it's owners, heirs, partners, agents, employes, contractors and affiliates of all claims. * I agree I have eaten before coming in today. * Yes No Please list any allergies Please check off any skin conditions you have in the area that you are getting tattooed, or that might effect the healing of the tattoo Psoriasis Eczema Contact Dermatitis Scarring Stretch Marks Acne Other If you selected other in the previous question, please elaborate By submitting this form I agree to the terms of this legal document and any false information will be considered misrepresentation and fraud. * I agree Thank you!