The Serpent Tattoo Consent Form

Please fill out the following form on the day of your tattoo appointment.

First name

Last name

Phone

Address

Date of birth

Photo of Driver's License, Non Driver ID, or Passport

I am requesting the following tattoo:

Tattoo Description

Tattoo Placement on Body

Tattoo Artist

Nixie

Rachel

Guest Artist

If guest artist, type name here

I certify that I am 18 years or older and have presented a valid ID. I understand that minors presenting fake ID will be prosecuted.

I certify that I am not and will not be under the influence of drugs or alcohol during any part of the tattoo process including selection, approval of design, administration of the tattoo, approval of finished tattoo, and aftercare instructions. I certify that the decision to get a tattoo is mine alone.

I understand that tattoos are permanent, that they cause pain and discomfort, that they require aftercare, that an allergic reaction or infection is possible, and that I am responsible for the correct spelling, dates, and any other information contained in the tattoo. I understand that tattoos change over time and depending on the skin color and texture of the individual. I understand that tattooing is an art, and that it is not possible to exactly replicate a design as it appeared on paper.

I certify that I do not have any medical conditions that would make it inadvisable to get a tattoo at this time, including but not limited to: epilepsy, hemophilia, diabetes, heart disease, or pregnancy. I acknowledge that if I proceed with the process, I do so at my own risk.

I certify that I have been provided with aftercare instructions and that I am responsible for the healing of my own tattoo. I will not hold The Serpent Tattoo and Occult Shop or any of its tattoo artists, agents, or employees for any condition that emerges after the tattoo, including but not limited to infection, loss of color, ink blowouts, and scarring.

I certify that, to my knowledge, I am free from contagious infections or diseases including but not limited to: rashes, skin lesions, boils, skin parasites, and active bloodborne diseases such as HIV or hepatitis.

I ACKNOWLEDGE THAT THE ABOVE INFORMATION IS CORRECT AND THAT I UNDERSTAND THE RISKS OF THE TATTOO PROCEDURE. I HEREBY RELEASE, AND HOLD HARMLESS, THE TATTOO ARTIST, THE SERPENT TATTOO AND OCCULT SHOP, AND ANY AGENTS, EMPLOYEES AND ASSOCIATES THEREOF, FROM ALL MANNER OF LIABILITIES, CLAIMS AND DEMANDS, IN LAW AND EQUITY, WHICH I OR MY HEIRS HAVE OR MIGHT HAVE NOW OR HEREAFTER BY REASON OF COMPLYING WITH MY REQUEST TO BE TATTOOED.

Signature