I consent to receiving a tattoo which is a permanent change to my physical appearance through breaking the skin with a sterile single-use needle and application of body-safe pigment. I recognize that there could be health risks associated with this procedure. *

Yes

I hereby state that I am over the age of 18 and therefore able to consent to receiving tattoo services. *

Yes

I have been provided aftercare instructions and have had the opportunity to ask any questions I may have regarding the tattoo procedure. *

Yes

I understand that body art removal may not be possible, or if possible may result in scarring. *

Yes

I will not be under the influence of alcohol or drugs at the time of my appointment. *

Yes

I am not pregnant. *

Yes

I accept and assume responsibility for all risks and care of the tattoo. Not limited to infections, blowout and reactions during and after the tattoo. *

Yes

I will follow the advice and instructions given to me by Quiet Canary Tattoo and Mason Green for care of the tattoo and skin. I understand that if I do not follow the advice and instructions I am responsible for any negative results and will incur the cost of any touch-ups required by my artist. *

Yes

I accept that certain medications and pre-existing health conditions may interfere with the tattoo and healing process and that there may be increased complications. Consultation with a health professional before receiving a body art service is advised. *

Yes

I hereby release and forever discharge and hold harmless Quiet Canary Tattoo and Mason Green from any and all claims, damages or legal actions arising from or connected in any way with my tattoo, or the procedure and conduct used in performing my tattoo, to the fullest extent allowed by the law *

Yes

I accept all responsibility for the variation between design and the final tattoo and have chosen the artist for their style in past work. *

Yes

I release the rights of photos for the artist and shop to use for promotion and portfolios.

Yes

No

Full Mailing Address *

Address 1

Address 2

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