Tattoo Consent Agreement

This agreement is entered into between the Tattoo Shop and [Field 6] [Field 7] on the date of [Field 43]. This consent form has been created to ensure clear understanding and mutual agreement regarding the tattoo procedure to be conducted.

Personal Details:
Name: [Field 6] [Field 7]
Age: [Field 16]
Birth Date: [Field 8]
Phone: [Phone Number Field 17]
Email: [Email Field 18]
Address: [Address Line1 Field 20], [Address Line2 Field 21], [City Field 22], [State Field 23], [Zipcode Field 24], [Country Field 25]

Health & Skin Conditions:
Under the influence of drugs/alcohol: [Field 27]
Pregnant or nursing: [Field 28]
Communicable disease: [Field 29]
Skin conditions (Listed): [Field 31]
Medical History: [Field 32]

Consent & Agreements:
Permanent Change Consent: [Field 34]
Photograph Consent: [Field 35]
No Refund Policy: [Field 36]
Allergy Acknowledgment: [Field 37]
Aftercare Instructions Compliance: [Field 38]/[Field 39]
Indemnity Agreement: [Field 40]
Confirm Accuracy of Information: [Field 41]

Submission Details:
Ref No.: [Submission Reference]
Date: [Submission Date]