Fill Out Your Tattoo Release Form Below

Tattoo Release Form

Name

Date of Tattoo:

Tattoo Artist:

Sex:

Date Of Birth:

Address:

City:

State:

Zip Code:

Phone Number:

Email:

How did you hear about us?

Free Text

Initial Beside Each IF You Agree and the Statement is CORRECT

I AM NOT under the influence of drugs/ alcohol

I AM NOT Diabetic

I DO NOT have a heart condition that impedes me from being tattooed

I AM NOT HIV/AIDS positive

I AM NOT Pregnant

I DO NOT HAVE or have had Hepatitis or

I DO NOT have any physical or mental disabilities that impede me from getting tattooed

I AM electing to undergo this tattoo procedure by my own free will

Free Text

I have been informed, understand and furthermore agree that as with any invasive procedure.

Tattooing may involve health risks such as: Pain, bleeding, swelling, infection, scarring of the tattooed area, and nerve damage.

I have been informed and understand that the tattoo procedure should be considered permanent: that it can only be removed surgically and that any effective removal may

leave scarring or disfigurement.

Tattoo pigments/ inks are more than 99.9% organic with less than .1% non-metallic preservatives.

I understand that the final outcome of the tattoo may differ slightly in color, actual size , and design from the design chosen.

I agree to follow aftercare instructions as explained by my Tattoo Artist.

I agree to hold harmless Black Rhino Tattoo, or any employees of Black Rhino Tattoo, responsible for any complications that may arise with the tattoo from the procedure.

I have read, understand, and agree to all terms and conditions herein

Patron's Signature:

Parent or Guardians Signature (if client is under 18):

Date

Fill Out Your Tattoo Release Form Below

Tattoo Release Form

Tattoo Release Form

ADDRESS