First name

Last name

Birthday

Government ID (Driver’s License/Passport

Phone

Email

Address

Is the client over 18 years of age?

Yes

No

If No, please have Parent/Legan Guardian present with proper ID ready and they must fill out the fields below:

Full Name

Relationship

Phone #

Guardian Government ID (Drivers Licence/Passport

Birth Certificate of Minor

Tattoo Location & Description:

I am the legal guardian of the client and I give full consent for the body modification.

Guardian Signature:

Please Check the following:

I am not under the influence of alcohol or drugs during the tattoo and at least 24 hours before the tattoo, and I am voluntarily submitting to be tattooed by the White Wasp Tattoo Studio without duress or coercion.

I am not pregnant or nursing. I do not suffer from diabetes, epilepsy, hemophilia, heart condition(s), nor do I take blood thinning medication. I do not have any other medical or skin condition that may interfere with the procedure, application or healing of the tattoo. I am not the recipient of an organ or bone marrow transplant or, if I am, I have taken the prescribed preventative regimen of antibiotics that is required by my doctor in advance of any invasive procedure.

I do not have a mental impairment that may affect my judgement in getting the tattoo.

I have been fully informed of the inherent risks associated with getting a tattoo. Therefore, I fully understand that these risks, known and unknown, can lead to injury including but not limited to: infection, scarring, difficulties in the detection of melanoma and allergic reactions to tattoo pigment, latex gloves and/or soap.

I understand that the body art technician is not responsible if my body reacts negatitively. Having been informed of the potential risks associated with getting a tattoo I wish to proceed with the tattoo procedure and application and freely accept and expressly assume any and all risks that may arise from tattooing.

I understand that the body art technician’s suggestions are not to be confused with medical advice

I WAIVE AND RELEASE to the fullest extent permitted by law any person of the Tattoo Studio from all liability whatsoever, including but not limited to, any and all claims or causes of action that I, my estate, heirs, executors or assigns may have for personal injury or otherwise, including any direct and/or consequential damages, which result or arise from the procedure and application of my tattoo, whether caused by the negligence or fault of either the Tattoo Studio, or otherwise.

I will do my due diligence to read the aftercare instructions and I understand I am responsible for taking care of my body modification

The White Wasp Tattoo Studio has given me verbal and written instructions on the care of my tattoo while it's healing and is available online on The White Wasp Tattoo Studio's website. I understand and will follow them. I acknowledge that it is possible that the tattoo can become infected, particularly if I do not follow the instructions given to me. If any touch-up work to the tattoo is needed due to my own negligence, I agree that the work will be done at my own expense.

The White Wasp Tattoo Studio is not responsible for the meaning or spelling of the symbol or text that I have provide to them or chosen from the flash (design) sheets.

Variations in color and design may exist between the tattoo art I have selected and the actual tattoo when it is applied to my body. I also understand that over time, the colors and the clarity of my tattoo will fade due to unprotected exposure to the sun and the naturally occurring dispersion of pigment under the skin.

I agree and accept that a tattoo is a permanent change to my appearance and can only be removed by laser or surgical means, which can be disfiguring and/or costly and which in all likelihood will not result in the restoration of my skin to its exact appearance before being tattooed.

I release the right to any photographs taken of me and the tattoo and give consent in advance to their reproduction in print or electronic form.

I agree that The White Wasp Tattoo Studio has a NO REFUND policy on tattoos, piercing and/or retail sales and I will not ask for a refund for any reason whatsoever.

I agree to reimburse the Tattoo Studio for any attorneys' fees and costs incurred in any legal action I bring against The White Wasp Tattoo Studio and in which either the Artist of The White Wasp Tattoo Studio is the prevailing party. I agree that the courts of located in the County of Cache within the State of Utah shall have jurisdiction and venue over me and shall have exclusive jurisdiction for the purposes of litigating any dispute arising out of or related to this agreement.

I acknowledge that I have been given adequate opportunity to read and understand this document that it was not presented to me at the last minute and grasp that I am signing a legal contract waiving certain rights to recover damages against The White Wasp Tattoo Studio.

I am aware and understand the instruments used in my body modification are sterilized

Please check if any of the following apply to you:

Other Medical Conditions:

By signing below I give permission to the Body Art Technician at The White Wasp Tattoo Studio, LLC. to perform a body modification procedure. I have answered all the questions truthfully, I am aware and take full responsibility for the body modification process, healing, and daily aftercare procedure.

I agree to the Terms & Conditions and I understand there are no Refunds for any reason whatsoever.

Client Signature

TATTOO CONSENT FORM

Please Check the following:

Subscribe Form