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DAICON Tattoo Festival
DAICON Tattoo Festival
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Consent and Aftercare
Consent to Tattoo / Body Modification Procedure
TATTOO
Consent Form
YOUR NAME: *
DATE OF BIRTH: *
DRIVERS LICENSE / ID #: *
STREET ADDRESS: *
CITY: *
STATE: *
ZIP CODE: *
PHONE #: *
EMAIL ADDRESS: *
DATE OF PROCEDURE: *
ARTIST NAME: *
BOOTH #: *
TATTOO LOCATION ON BODY: *
ALLERGIES:
IF YOU HAVE ANY TYPE OF INFECTION OR COMMUNICABLE DISEASE, OPEN SORES, A BLOOD CONDITION, A RASH, OR OTHER SKIN CONDITION, STATE HERE
I acknowledge by signing this agreement that I have been given full opportunity to ask questions which I might have about the obtaining of a tattoo or piercing and that all my questions have been answered to my full satisfaction. I also acknowledge that: *
I am over the age of 18
I am not pregnant or nursing
I am not under the influence of drugs or alcohol
I do not have any medical or skin conditions such as (but not limited to) acne, scarring (keloid), eczema, psoriasis, freckles, moles, any other skin condition or lesion, or sunburn in the area that will be modified that might interfere with the required procedure
I acknowledge that it is not reasonably possible for any Artist to determine whether or not I may have an allergic response or reaction to the needles or pigments used during my body modification, and agree to accept the potential risk that a reaction might be possible. If I am aware of any allergies, I listed them in the above allergy question.
I acknowledge that infection is always a possibility with any body modification, particularly in the event that I do not follow proper aftercare procedures (see Aftercare Section)
I realize that variations in color and design may occur in any tattoo design as selected and agreed upon when it is applied to living skin. I understand that differentiation in skin tone will likely change the appearance of colors and shading from a design image, i.e. from a phone image or iPad design, but that the artist will strive to achieve all expectations to the best of their abilities
I understand that if I have any skin treatments, laser hair removal, plastic or corrective surgery, or any other skin-altering procedures, adverse effects to my modification may occur
I acknowledge that a tattoo is a permanent change to my appearance, and that no representations have been made nor implied to me as to the success of a future change or removal of my tattoo. To my knowledge, I do not have a physical, mental, or emotional impairment or disability that might affect my well-being, directly or indirectly, as a result of my decision to have this body modification procedure
I do not have a neurological or immunocompromised condition or disorder, including but not limited to diabetes, hemophilia, a history of epilepsy/seizures/fainting/narcolepsy
If I have any condition that might affect the healing of this modification, I will advise my artist. This includes allergies or adverse reactions to anticoagulants or NSAIDs and/or certain types of disinfectants
I have received aftercare instructions from my artist, and I agree to follow them while my tattoo or piercing is healing. I agree that any follow-up or touch-up work that may be needed due to my own negligence will be at my own expense
I have truthfully represented to my artist that the obtaining of this body modification is by my choice alone. I consent to this procedure of my own free will
SIGNATURE (Full Name): *
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BODY MOD (PIERCING)
Consent Form
YOUR NAME: *
DATE OF BIRTH: *
DRIVERS LICENSE / ID #: *
STREET ADDRESS: *
CITY: *
STATE: *
ZIP CODE: *
PHONE #: *
EMAIL ADDRESS: *
DATE OF PROCEDURE: *
ARTIST NAME: *
BOOTH #: *
PIERCING LOCATION ON BODY: *
Leave this field empty
Submit form