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INK COLLECTIVE 77 TATTOO CONSENT FORM
First Name
Last Name
Date of Birth
Home Address
Email
To my knowledge i do not or have not suffered from any of the following:
Heart Disease or taking any blood thinning medication
*
Required
Yes
No
Eczema or any skin conditions
*
Required
Yes
No
Inpetigo or any other contagious skin rash
*
Required
Yes
No
Haemorrhaging
*
Required
Yes
No
Epilepsy or any other seizure inducing conditions
*
Required
Yes
No
Diabetes(if yes please specify the type in the text box below)
*
Required
Yes
No
HIV infection, Hepatitis A, B or C
*
Required
Yes
No
Acne, psoriasis or Cellulitis
*
Required
Yes
No
Have you consumed alcohol or drugs in the last 24 hours?
*
Required
Yes
No
Are you pregnant?
*
Required
Yes
No
Any Allergic Responses? Latex/Plasters (if yes please specify in the text box below
*
Required
Yes
No
If Yes to any please specify
Current Date
I Understand i must be 18 years of age or older to be tattooed. This consent form is to certify that i, the above named, do give my permission to be pierced/tattooed. I am fully aware of the process involved, the permanent nature of a tattoo or piercing and understand the importance of the daily aftercare procedure. I agree to indemnify and keep indemnified the supplier against all claims or proceedings of any personal injury or damage arising out of, or as a result of, the supply of service. I agree to receiving emails from Inkcollective77
tattoo@inkcollective77.com
I Consent
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