Consent Form

Drawn up in duplicate on (date): *

The undersigned (name): *

Photos'may be taken and used for commercial purposes. If you wish that NO photo's be taken, please also inform your artist of this.

• Approved

Name on Instagram

Date of birth: *

Phone number: *

Zip code: *

Description of the tattoo: *

Email *

My email address may be included for commercial purposes

• Read & approved

It is shown that only individually sterilized, pre-packaged materials are used and under proper conditions. I certify that I am not under the influence of drink, drugs or blood thinners. I understand that infections can occur due to inadequate and/or improper hygiene. Therefore, the aftercare instructions on the enclosed sheet should be followed for as long as the recommended healing period lasts. My body part to be tattooed does not currently show any skin problems (discoloration, swelling, bumps) I will inform the person in charge of tattoo shop Inksane if I charge from any form of epilepsy, diabetes, heart disease, blood pressure problems, hemophilia, allergy or immune disorder, latex allergy, hepatitis, AIDS, am pregnant or if I have undergone plastic surgery. I certify that I am physically able, specifically in terms of maturity, to undergo the operation. *

• Read & approved.

Artist *

• Sandy Verfaille

My chosen artist from tattoo shop Inksane cannot be held responsible for infections, allergic reactions and/or damage that may result directly or indirectly from the tattoo. Client is informed that she will still proceed with tattoo placement on her own responsibility. *

• Read and approved

Signature

Clear Signature

Submit