Name
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First Name
Last Name
Date of Birth
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MM
DD
YYYY
Email
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Age
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Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Tattoo Description
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Please read, review and agree to the following:
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I have been given the opportunity to discuss all concerns or questions I may have regarding my tattoo and all questions have been answered to my fulI satisfaction. Any tattoo that has spelling, symbols, or foreign languages has been verified by myself and I accept full responsibility for the accuracy. I understand a copy of this release is available to me at my request.
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I grant The Hive Tattoo an irrevocable license to use any photos taken during the process of my tattoo in any manner they deem fit. Not limited to and including, portfolios, advertisements, and promotional materials. The Hive Tattoo has no obligation to use any likeness of me.
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I acknowledge by my signature that I am over the age of 18. I have presented my valid identification and all information provided by me is true and accurate. I understand that misrepresenting my age, or falsifying any information, or identification is a federal offense and makes me liable for prosecution.
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I do not have any physical, mental, medical impairment, or disability, which might affect my well-being as a direct or indirect result of my decision to be tattooed. I am of sound mind and body.
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I am not under the influence of any drugs or alcohol. I have eaten in the last 3 hours. lf female, I am NOT pregnant or nursing.
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I understand prior to getting tattooed that it is important to consult a medical professional about all drug indications, especially with regard to blood thinners. In addition, I acknowledge that if I have any communicable diseases or medical conditions I have consulted with a qualified physician to discuss possible complications due to getting tattooed and have been given full medical approval to obtain this procedure.
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I agree to follow all healing aftercare instructions given by my tattoo artist, unless doing so goes against any medical advice. I will immediately consult with my tattoo artist for any additional questions or concerns regarding the healing process of my tattoo.
I recognize that the tattoo process may adversely affect the following conditions or itself be adversely affected by these conditions. These conditions include but are not limited to:
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Heart Problems, Hepatitis, Diabetes, Epilepsy, MRSA/Staph, Psoriasis, Allergies, Hemophilia, Anemia, Cold Sores, Eye Problems, History of Seizure/Fainting, History of Keloid scarring, HIV/Hepatitis/Lupus or other Auto-Immune Diseases, Moles/Freckles or Skin Problems, including Sunburn at the site of tattoo.
Artist
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Date
MM
DD
YYYY
