Release Waiver with Deposit ($25)

Name *

First

Last

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Please 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? *

What 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 *

Date 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: $ 25.00

Payment Information *

Card

Name on Card