TATTOO APPOINTMENT
Release and Hold Aggreement

Do you have any allergies to any of the following? *

Antibiotics

Soaps

Metals

Cosemetics

Latex

Alcohol

Other

I do not have any allergies

Do you have or are you subject to any of the following? *

Fainting/ Dizziness

High Blood Pressure

Rashes

Sensitive Skin

IV drug use

Diabetic

Epileptic

Seizures

Unusual Scarring

Cysts

Psoriasis

Eczema

None

I acknowledge that I am 18 years or older.

Yes, I have read and fully understand all the terms and conditions outlined in this document.

Name *

First Name

Last Name

Phone *

(###)

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth *

MM

DD

YYYY

Today's Date

MM

DD

YYYY

By checking this box I am acknowledging I have read and agree to all the above terms and conditions outlined in this document and will abide by them while in Crimson Dawn Collective. *

Yes, I have read and agree to all the above terms and conditions outlined in this document and will abide by them while in Crimson Dawn Collective.

I acknowledge that if I am 17 years or younger that my parent or guardian will be present at the tattoo appointment. They have also seen this form and give their permission for this tattoo.

Yes, I have read and fully understand all the terms and conditions outlined in this document.

Name

First Name

Last Name

Phone

(###)

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