........CONSENT TO TATTOO PROCEDURE

I acknowledge by accepting this agreement that I have been given the full opportunity to ask any all questions which I might have about obtaining of a tattoo and that all 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 agree as follows.

• If I have diabetes, epilepsy, hepatitis, hemophilia, HIV-AIDS or any other communicable disease, heart condition or take medicine which thins the blood I have advised my tattooer. I am not pregnant or nursing. I am not under the influence of alcohol or drugs.
• I do not have medical or skin conditions such as but not limited to: acne, scarring (Keloid), eczema, psoriasis, freckles, moles or sunburn in the area to be tattooed that may interfere with said tattoo.
• 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 pigments or processes used in my tattoo and I agree to accept the risk that such a reaction is possible.
• 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 agree to follow them while my tattoo is healing. I agree that any touch-up work needed, due to my own negligence, will be done at my own expense.
• I realize that variations in color and design may exist between any tattoo as selected by me and as ultimately applied to my body. I understand that if my skin color is dark, the colors will not appear as bright as they do on light skin.
• I understand that if I have any skin treatment, 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 acknowledge I am over the age of eighteen and that I have truthfully represented to my tattooer 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.
• TO MY ACKNOWLEDGEMENT I DO NOT HAVE AN ALLERGY TO NATURAL RUBBER LATEX. I DO ACKNOWLEDGE THAT THE GLOVES BEING USED CONTAIN NATURAL RUBBER LATEX WHICH MAY CAUSE ALLERGIC REACTIONS.

  		Date/Fecha
  Name/Nombre		Last/Apellido
  Adress/Direccion		City/Ciudad
  State/Estado		Zip/Codigo
  Age		Dob/Fecha de nacimiento
  Phone/Telefono
  Tattoo design/ Diseno		Artist
  Price/Precio	+ tax
  Email/Correo
  		Upload ID
  SHOP LOCATION
  Corona
  Jackson Heights
  Harrison
  Please make a selection. Accept Agrrement
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