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Last Name

Address *

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Date of Birth *

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I would like to be added to the Thorns email newsletter list

I acknowledge by signing this agreement that I have been given the full opportunity to ask any and all questions which I might have about the obtaining of a tattoo and that all of my questions have been answered to my full satisfaction. I specifically acknowledge I have been advised of the facts and matters set forth below and I agree as follows: *

If I have any condition that might affect the healing of this tattoo, I will inform my tattooer. I am not under the influence of alcohol or drugs.

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I do not have medical or skin conditions such as but not limited to: acne, scarring (Keloid) eczema, psoriasis, freckles, moles or sunburn in the area to be tattooed that may interfere with said tattoo. If I have any type of infection or rash anywhere on my body, I will advise my tattooer.

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I acknowledge it is not reasonably possible for my tattoo artist to determine whether I might have an allergic reaction to the pigments or processes used in my tattoo, and I agree to accept the risk that such a reaction is possible.

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I acknowledge that infection is always possible as a result of the obtaining of a tattoo, particularly in the event that I do not take proper care of my tattoo. I have received aftercare instructions and I agree to follow them while my tattoo is healing. I agree that any touch-up work needed, due to my own negligence, will be done at my own expense.

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I realize that variations in color and design may exist between any tattoo as selected by me and as ultimately applied to my body. I understand that colors might heal and appear differently on my skin than the bottle.

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I understand that if I have any skin treatments, laser hair removal, plastic surgery or other skin altering procedures, it may result in adverse changes to my tattoo.

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I acknowledge that a tattoo is a permanent change to my appearance and that no representations have been made to me as to the ability to later change or remove my tattoo. To my knowledge, I do not have a physical, mental or medical impairment or disability which might affect my well being as a direct or indirect result of my decision to receive a tattoo.

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I consent to the application of the tattoo and to any actions or conduct of the representatives and employees of the tattoo shop reasonably necessary to perform the tattoo procedure.

COVID-19 Liability Release Waiver *

Due to the 2019-2020 outbreak of the novel Coronavirus (COVID-19), our business is taking extra precautions with the care of every client to include health history review and enhanced sanitation/disinfecting procedures in compliance with CDC guidance. Symptoms of COVID-19 include: • Fever • Fatigue • Dry Cough • DifficultyBreathing I agree to the following:

I understand the above symptoms and affirm that I, as well as all household members, do not currently have, nor have experienced the symptoms listed above within the last 14 days.

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I affirm that I, as well as all household members, have not been diagnosed with COVID-19 within the past 30 days.

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I understand that Thorns Tattoo cannot be held liable for any exposure to the COVID-19 virus caused by misinformation on this form or the health history provided by each client.

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