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Parent/Guardian
Tattoo Consent Form

Please fill out form in its entirety.

Medical Information

Are you pregnant and/or breast-feeding?
Do you have a heart condition/​epilepsy/​diabetes?
Are you a hemophiliac or on any medications that may cause bleeding and/​or hinder blood clotting?
Do you have any communicable diseases? (eg HIV, AIDS, Hepatitis)
Are you under the influence of alcohol and/​or drugs, prescribed or otherwise?
Do you have any allergies? (medication or topical solutions)

Consent Agreement

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Please check each box below in agreement.

Parent/Guardian Consent Agreement

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Please check each box below in agreement.

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