I voluntarily consent to this tattoo or piercing procedure of my own free will. I am sober and free from drugs and alcohol. I certify that I am not under the influence of any controlled substance. I certify that I have eaten within the last 4 hours. I certify that I am at least 18 years of age. I certify that the information I have provided is true and correct to the best of my knowledge.

To induce the above-named artist to tattoo/pierce my (location of tattoo/piercing) and in consideration of their doing so, I hereby release the above-named artist from all liability, claims, damages, lawsuits, and demands, in law or equity, to the fullest extent permitted by law, which I, my heirs, executors, or assigns may now or hereafter have, arising from or related to complying with my request to be tattooed or pierced.

I understand that any tattoo should be considered permanent; that it can only be removed with a surgical procedure; and that any effective removal may leave scarring. Body piercing may leave scarring.

I understand that I will be tattooed or pierced using appropriate techniques to ensure proper healing. I agree to follow the procedures outlined on the accompanying care form for the care of the tattoo or piercing until healing is complete. I understand that the tattoo or piercing may take two (2) or more weeks to heal.

I further understand that even with appropriate techniques, instruments, and the utmost of care, infection is always possible, and I assume the risk of such infection regardless of its cause. I further understand that there is always the possibility of an allergic reaction to some of the tattooing pigments and I assume the risk of such allergic reactions.

I acknowledge that I am not suffering from, nor do I have a history of: diabetes, HIV, HBV, hemophilia, jaundice, immune disorders, epilepsy, seizures, fainting, narcolepsy, any condition that requires the customer to take medications such as anticoagulants that thin the blood or interfere with blood clotting, or medications that weaken the immune system, or any other condition that would make this procedure dangerous.

I further acknowledge that I do not currently suffer from, nor do I have a history of: allergies, adverse reactions to pigments, dyes, discoloration, swelling, lumps, scarring (keloid), skin diseases, skin lesions, skin sensitivities to soap or disinfectants, or other types of irritation of the area to be tattooed or pierced. I certify that I am not pregnant or breastfeeding.
The above-named artist makes no warranties as to the meaning of any tattooed symbols or designs. The above-named artist is not responsible for any complications due to mistreatment or improper care of the tattoo or piercing.

The artist shall not perform a body art procedure if the customer fails to complete or sign the disclosure and authorization form, and the artist may decline to perform a body art procedure if the customer has any identified health conditions.

Contact a qualified healthcare professional at the first sign of abnormal inflammation, swelling, or possible infection.

I certify that the above information is true and correct to the best of my knowledge. I enter in this agreement on my free will and I am in a sober (drug and alcohol free) condition. I certify that I am at least 18 years of age.

To induce the above named artist to tattoo/pierce my (location of tattoo/piercing) and in consideration of their doing so, I hereby release the above named artist from all liability, claims, damages, lawsuits, and demands, in law or equity, to the extent allowed by law, which I or my heirs might have now or hereafter, arising from or for complying with my request to be tattooed.

Tattooing inserts pigments into the skin. I understand that any tattoo should be considered permanent; that it can only be removed with a surgical procedure; and that any effective removal may leave scarring. Tattoo Inks, Dyes and Pigments have not been approved by the FDA and the health consequences of using these products are unknown. Body piercing uses a needle to create an opening in the skin, cartilage, or mucous membrane to insert jewelry and may leave scarring.

I understand that I will be tattooed using appropriate techniques to ensure proper healing of my tattoos. I agree to follow the procedures outlined on the accompanying care form for the care of tattoo until healing is complete. I understand that this type of tattoo takes 2 or more weeks to heal.

I further understand that even with appropriate techniques, instruments, and the utmost of care, infection is always possible, and assume the risk of such infection regardless of its cause. I further understand that there is always the possibility of an allergic reaction to some of the tattooing pigments and assume the risk of such allergic reactions.

I acknowledge that I am not suffering from or history of: diabetes, allergies, AIDS, HSV, herpes infection at the proposed procedure site, bleeding disorders, hemophilia, immune disorders, epilepsy, seizures, fainting, narcolepsy, cardiac valve disease, allergies to latex or antibiotics, adverse reactions to pigments, dyes or other skin sensitivities, discoloration, swelling, lumps, scarring (keloid), skin diseases, skin lesions or skin sensitivities to soap, disinfectants, etc. or other types of irritation of the area to be tattooed, pregnancy or breast-feeding/nursing or any other condition that would make this procedure dangerous.

Please disclose any condition that requires the client to take medications such as anticoagulants that thin the blood or interfere with blood clotting, whether you have recently taken anti-biotics for a surgical procedure or any other information that would aid the technician in the body art procedure. Also, the last time you ate.

The above named artist makes no warranties as to the meaning of any tattooed symbols or designs. The above named artist is not responsible for any complications due to mistreatment of the tattoo.

The technician shall not perform a body art procedure if the client fails to complete or sign the disclosure and authorization form, and the technician may decline to perform a body art procedure if the client has any identified health conditions.

Contact a qualified health care professional at the first sign of abnormal inflammation, swelling or possible infection!

I certify that the above information is true and correct to the best of my knowledge. I enter in this agreement on my free will and I am in a sober (drug and alcohol free) condition. I certify that I am at least 18 years of age. I certify that I have eaten within the last 4 hours.

To induce the above named artist to tattoo/pierce my (location of tattoo/piercing)_______________ and in consideration of their doing so, I hereby release the above named artist from all liability, claims, damages, lawsuits, and demands, in law or equity, to the extent allowed by law, which I or my heirs might have now or hereafter, arising from or for complying with my request to be tattooed. The above named artist makes no warranties as to the meaning of any tattooed symbols or designs.

I understand that any tattoo should be considered permanent; that it can only be removed with a surgical procedure; and that any effective removal may leave scarring. Body piercing may leave scarring. Please ask your artist if you have any questions.

I understand that I will be tattooed using appropriate techniques to ensure proper healing of my tattoos. I agree to follow the procedures outlined on the accompanying care form for the care of tattoo until healing is complete. I understand that this type of tattoo takes 2 or more weeks to heal. Please ask your artist if you have any questions.

I further understand that even with appropriate techniques, instruments, and the utmost of care, infection is always possible, and assume the risk of such infection regardless of its cause. I further understand that there is always the possibility of an allergic reaction to some of the tattooing pigments and assume the risk of such allergic reactions.

I acknowledge that I am not suffering from or history of: diabetes, or any disorder or medication that affects the neurological or immune system in fighting infection, any other blood clotting abnormalities, allergies, HIV/AIDS, Hepatitis B, Hepatitis C, hemophilia, immune disorders, epilepsy, seizures, fainting, narcolepsy, allergies such as latex allergies or adverse reactions to pigments, dyes or other skin sensitivities, discoloration, swelling, lumps, scarring (keloid), skin diseases, skin lesions or skin sensitivities to soap, disinfectants, etc. or other types of irritation of the area to be tattooed, pregnancy, have been pregnant in the last 3 months or breast-feeding/nursing or any other condition that would make this procedure dangerous.

Please disclose any condition that requires the client to take medications such as Aspirin or other anticoagulants (such as Warfarin, Xarelto, Plavix, Eliquis, etc.) which thin the blood or interfere with blood clotting, or any other information that would aid the technician in the body art procedure. Client shall consult a physician prior to the procedure if they have any concerns related to the evaluation questions. The health conditions outlined in the evaluation may increase health risks associated with receiving a body art procedure. The above named artist is not responsible for any complications due to mistreatment of the tattoo. The technician shall not perform a body art procedure if the client fails to complete or sign the disclosure and authorization form, and the technician may decline to perform a body art procedure if the client has any identified health conditions. These conditions may increase your health risks associated with tattoos.

The client shall contact the Chatham County Health Department with any complaint, question or concern regarding safety, sanitation, or sterilization procedures.

Local Health Department Contact Information
Chatham County Health Department
1395 Eisenhower Dr, Savannah, GA 31406
912-356-2160

Please contact a qualified health care professional at the first sign of abnormal inflammation, swelling or possible infection.

I HAVE CAREFULLY READ THIS CONSENT AND RELEASE FORM AND BY SIGNING SAME, AGREE TO ITS TERMS.

I certify that the above information is true and correct to the best of my knowledge. I enter in this agreement on my free will and I am in a sober (drug and alcohol free) condition. I certify that I am at least 18 years of age.

To induce the above named artist to tattoo/pierce my (location of tattoo indicated above and/or in physical form) and in consideration of their doing so, I hereby release the above named artist from all liability, claims, damages, lawsuits, and demands, in law or equity, to the extent allowed by law, which I or my heirs might have now or hereafter, arising from or for complying with my request to be tattooed.

I understand that any tattoo should be considered permanent; that it can only be removed with a surgical procedure; and that any effective removal may leave scarring. Body piercing may leave scarring.

I understand that I will be tattooed using appropriate techniques to ensure proper healing of my tattoos. I agree to follow the procedures outlined on the accompanying care form for the care of tattoo until healing is complete. I understand that this type of tattoo takes 2 or more weeks to heal.

I further understand that even with appropriate techniques, instruments, and the utmost of care, infection is always possible, and assume the risk of such infection regardless of its cause. I further understand that there is always the possibility of an allergic reaction to some of the tattooing pigments and assume the risk of such allergic reactions.

I acknowledge that I am not suffering from or history of: diabetes, allergies, AIDS, hemophilia, immune disorders, epilepsy, seizures, fainting, narcolepsy, allergies or adverse reactions to pigments, dyes or other skin sensitivities, discoloration, swelling, lumps, scarring (keloid), skin diseases, skin lesions or skin sensitivities to soap, disinfectants, etc. or other types of irritation of the area to be tattooed, pregnancy or breast-feeding/nursing or any other condition that would make this procedure dangerous.

Any condition that requires the client to take medications such as anticoagulants that thin the blood or interfere with blood clotting, or any other information that would aid the technician in the body art procedure. Also last time you ate.

The above named artist makes no warranties as to the meaning of any tattooed symbols or designs. The above named artist is not responsible for any complications due to mistreatment of the tattoo.

The technician shall not perform a body art procedure if the client fails to complete or sign the disclosure and authorization form, and the technician may decline to perform a body art procedure if the client has any identified health conditions.

Contact a qualified health care professional at the first sign of abnormal inflammation, swelling or possible infection.

I HAVE CAREFULLY READ THIS CONSENT AND RELEASE FORM AND BY SIGNING SAME, AGREE TO ITS TERMS.

I certify that the above information is true and correct to the best of my knowledge. I enter in this agreement on my free will and I am in a sober (drug and alcohol free) condition. I certify that I am at least 18 years of age.

To induce the above named artist to tattoo/pierce my (location of tattoo) and in consideration of their doing so, I hereby release the above named artist from all liability, claims, damages, lawsuits, and demands, in law or equity, to the extent allowed by law, which I or my heirs might have now or hereafter, arising from or for complying with my request to be tattooed.

I understand that any tattoo should be considered permanent; that it can only be removed with a surgical procedure; and that any effective removal may leave scarring. Body piercing may leave scarring.

I understand that I will be tattooed using appropriate techniques to ensure proper healing of my tattoos. I agree to follow the procedures outlined on the accompanying care form for the care of tattoo until healing is complete. I understand that this type of tattoo takes 2 or more weeks to heal.

I further understand that even with appropriate techniques, instruments, and the utmost of care, infection is always possible, and assume the risk of such infection regardless of its cause. I further understand that there is always the possibility of an allergic reaction to some of the tattooing pigments and assume the risk of such allergic reactions.

I acknowledge that I am not suffering from or history of: diabetes, allergies, AIDS, hemophilia, immune disorders, epilepsy, seizures, fainting, narcolepsy, allergies or adverse reactions to pigments, dyes or other skin sensitivities, discoloration, swelling, lumps, scarring (keloid), skin diseases, skin lesions or skin sensitivities to soap, disinfectants, etc. or other types of irritation of the area to be tattooed, pregnancy or breast-feeding/nursing or any other condition that would make this condition dangerous.

Any condition that requires the client to take medications such as anticoagulants that thin the blood or interfere with blood clotting, or any other information that would aid the technician in the body art procedure. Also last time you ate.

The above named artist makes no warranties as to the meaning of any tattooed symbols or designs. The above named artist is not responsible for any complications due to mistreatment of the tattoo.

The technician shall not perform a body art procedure if the client fails to complete or sign the disclosure and authorization form, and the technician may decline to perform a body art procedure if the client has any identified health conditions.

Contact a qualified health care professional at the first sign of abnormal inflammation, swelling or possible infection!

I HAVE CAREFULLY READ THIS CONSENT AND RELEASE FORM. BY SIGNING BELOW, I AGREE TO ITS TERMS

I certify that the above information is true and correct to the best of my knowledge. I enter in this agreement on my free will and I am in a sober (drug and alcohol free) condition. I certify that I am at least 18 years of age.

To induce the above named artist to tattoo/pierce my (location indicated above) and in consideration of their doing so, I hereby release the above named artist from all liability, claims, damages, lawsuits, and demands, in law or equity, to the extent allowed by law, which I or my heirs might have now or hereafter, arising from or for complying with my request to be tattooed. The above named artist makes no warranties as to the meaning of any tattooed symbols or designs.

I understand that any tattoo should be considered permanent; that it can only be removed with a surgical procedure; and that any effective removal may leave scarring. Body piercing may leave scarring.

I understand that I will be tattooed using appropriate techniques to ensure proper healing of my tattoos. I agree to follow the procedures outlined on the accompanying care form for the care of tattoo until healing is complete. I understand that this type of tattoo takes 2 or more weeks to heal.

I further understand that even with appropriate techniques, instruments, and the utmost of care, infection is always possible, and assume the risk of such infection regardless of its cause. I further understand that there is always the possibility of an allergic reaction to some of the tattooing pigments and assume the risk of such allergic reactions.

I acknowledge that I am not suffering from or history of: diabetes, or any disorder or medication that affects the neurological or immune system in fighting infection, any other blood clotting abnormalities, allergies, AIDS, Hepatitis B, Hepatitis C, hemophilia, immune disorders, epilepsy, seizures, fainting, narcolepsy, allergies such as latex allergies or adverse reactions to pigments, dyes or other skin sensitivities, discoloration, swelling, lumps, scarring (keloid), skin diseases, skin lesions or skin sensitivities to soap, disinfectants, etc. or other types of irritation of the area to be tattooed, pregnancy, have been pregnant in the last 3 months or breast feeding/nursing or any other condition that would make this procedure dangerous.

Please disclose any condition that requires the client to take medications such as anticoagulants that thin the blood or interfere with blood clotting, or any other information that would aid the technician in the body art procedure. You must have eaten within the last 4 hours.

The above named artist is not responsible for any complications due to mistreatment of the tattoo. The technician shall not perform a body art procedure if the client fails to complete or sign the disclosure and authorization form, and the technician may decline to perform a body art procedure if the client has any identified health conditions. These conditions may increase your health risks associated with tattoos.