Name
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First Name
Last Name
Email
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Phone
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(###)
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Date of Birth
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MM
DD
YYYY
Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Artist
Please describe the design and placement of your desired tattoo.
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Please list any allergies or medical conditions you may have.
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Please list any medications you are currently taking, prescription or over the counter.
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Please check all that apply.
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Diabetes
Epilepsy
Nursing
HIV/AIDS
Hemophilia
Herpes
Heart Condition
Eczema/Psoriasis
Scarring/Keloiding
Faint or Dizzyness
Infections
Asthma
Hepatitis
Pregnancy
Blood Thinners
Tuberculosis
None of the above
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I agree to eat a healthy meal, the night before, and 1-2 hours prior to getting my tattoo.
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I agree to stay well hydrated the day before and the day of my tattoo procedure.
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I understand that the tattoo is permanent.
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I am 18 years or older.
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I am not under the influence of drugs or alcohol, and will not be during the tattoo procedure.
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I understand that there is a possibility of an allergic reaction
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I understand that there is a possibility of infection
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I understand there is a chance I may feel, dizzy, lightheaded and/or faint due to my choice to receive this tattoo.
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I agree to IMMEDIATELY notify the artist in the event that I feel dizzy, lightheaded and/or faint before, during, or after the procedure. FAILURE TO DO SO RELEASES REDEMPTION INK & GLASS AND ALL ARTISTS ASSOCIATED OF ALL RESPONSIBILITY.
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I understand there are no refunds.
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I have approved the proposed pattern, design, drawing and/or lettering.
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I release Redemption Ink & Glass, along with all associated artist, of any responsibility for the care of my tattoo.
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All of my questions have been answered to my satisfaction.
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I agree to follow all instructions concerning the care of my tattoo.
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I hereby certify that all information provided is correct, to the best of my knowledge.
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I understand, that by submitting this form, I have read and understand all terms and conditions stated.
By typing your name below, you agreed to the above conditions.
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