Consent & Release Form | Kein Unsinn Inc

Have you already scheduled an appointment with the tattoo artist?

First name of Client

Last name of Client

Will the tattoo session be for you or for someone for whom you are legally responsible?

I will be the client participating in the tattoo session.

I am the legal parent / custodian / guardian of a minor client participating in the tattoo session.

Are you at least 18 years of age?

Clients must be at least 18 years of age or have a consenting adult complete this form.

Date of birth

Month

Day

Year

Drivers License/State ID Number

File upload

Please submit a photo of the front and back of your drivers license or state identification card.

The following questions pertain to the Client's health & medical background information that will be relevant to the tattoo session.

Have you been hospitalized in the last 12 months?

Yes

Are you suffering from a medical condition, illness or injury?

Yes

Examples: diabetes, epilepsy, hepatitis, hemophilia, HIV/AIDS, any communicable disease, heart condition, pregnancy, nursing status, blood-thinning medication, or impairment from alcohol or drugs.

Do you have any skin conditions?

Yes

Examples: infection, rash, lesion, mole, sunburn, scarring tendency, or other condition affecting the area to be tattooed.

I declare that the information I have provided above is accurate and complete.

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