Pre-Tattoo Form Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Phone *Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePlease upload an image of your Driver's License * Click or drag a file to this area to upload. *Front of license is only required.Do you have any known allergies to latex, iodine, or other products routinely used in a body art procedure? *YesNoWhat allergies do you have? *Acknowledgement *I acknowledge by signing this agreement that I have been given the full opportunity to ask any and all questions which I might have about the obtaining of a tattoo and that all of 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 I agree as follows:I understand that there are risks associated with body art procedures such as the risk of fainting, vomiting, and infection including bacterial endocarditis for patrons with a heart condition.If I have diabetes, epilepsy, hepatitis, lupus, hemophilia, HIV-AIDS, or any other communicable disease, heart condition or take medicine which thins the blood I have advised my tattooist. 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, rash, infection, lesion, freckles, moles or sunburn in the area to be tattooed that may interfere with said tattoo. If I have any type of infection, rash, or lesion anywhere on my body, I will advise my tattooist.If I have ingested blood thinners such as aspirin or ibuprofen within 24 hours prior to my body art procedure, I will advise my tattoo artist.If I have not eaten within two hours prior to receiving my body art procedure, I will notify my tattoo artist.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 I agree to follow them while my tattoo is healing. I agree that any touch-up work needed, due to my own negligence or failure to follow such instructions, 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 treatments, 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 tattooist 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.I understand that Kaitlin Peterson reserves all rights to use any photos of my tattoo taken.By signing below, I, or my legal guardian, agree that I have read the tattoo release form provided by Kaitlin Peterson and agree to its terms.Signature *Clear SignatureDate of Tattoo * Deposit Details Deposits will go toward the cost of the tattoo, unless specified otherwise. All (re)scheduling must be done within 30 days upon leaving a deposit or original appointment date. If an agreement hasn't been made within 30 days of leaving the deposit or cancelling your original appointment, your deposit will be forfeited. All cancellations / reschedules without 72 hours notice to scheduled appointment date will forfeit their deposit. No-call / no-shows also forfeit their deposit and may be declined any future service. Tattoo Deposit Amount *Price: $ 25.00Payment Information *CardName on CardSubmit Email hello@kaittattoos.com Social Media FollowFollow