Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

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

Agree

I acknowledge that infection is always possible, particularly in the event that I do not take proper care of my tattoo.

Agree