Tattoo Waiver for Harry

Name of Premises: Lemon Head Tattoos Ltd
Address of Premises: Unit 1, ABC Wharf, 165 King St, Norwich NR1 1QH
Name of Practitioner: Harry Newman
Full Name of Client:
Date of Appointment:
Address of Client:
Telephone Number of Client:
Email Address of Client:
Date of birth:
ID used to Prove Age: —Please choose an option—PassportDriving LicenceStudent CardNational ID Card*Please note you MUST bring your ID with you to your appointment.
Site of Tattoo on Body: —Please choose an option—Left ArmRight ArmLeft LegRight LegNeck/FaceChest/TorsoBack
GP Name and Address Details:

Individual Consent

Please read the release and waiver of all claims and sign below:

I declare that I give my full consent to the tattooing being carried out by the aforementioned practitioner. I confirm that potential complications for the undertaken procedure (e.g. infection and swelling) have been explained to me.

I confirm that aftercare advice has been given to me and note that full detailed and written guidance is available at all times at lemonheadtattoos.co.uk/tatto0-aftercare and that it is my responsibility to read this and follow the instructions on it, until the site has healed.

I agree to release and discharge Lemon Head Tattoos Ltd and all its independent freelancers from any and all claims, damages, and legal actions arising from - or connected in any way - with my tattoo and the procedures and conduct used to apply my tattoo.

I confirm that if I have diabetes, epilepsy, hepatitis, haemophilia, HIV-AIDS or any other communicable disease, heart condition or I take medication that thins the blood, I have advised my practitioner.

I confirm I am not pregnant or breastfeeding.

I confirm that it is not reasonably possible for the practitioner to determine if I might have an allergic reaction to the pigments or processes used in my tattoo. I agree to accept that the risk of such a reaction is possible.

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

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 any physical, mental or medical impairment or disability that might affect my well being as a direct or indirect result of my decision to have a tattoo.

I acknowledge that the artists are not translators and cannot guarantee the spelling or meaning of foreign words or symbols. I confirm that the spelling of any words to be used for the tattoo are correct and to my liking.

If I am unable to sit through the tattooing process, I give the artist permission to decide if the tattoo can be continued in another session.

I understand that tattoo(s) are created by hand and the appearance of the artwork will differ from the tattooed procedure.

I agree to allow Lemon Head Tattoos Ltd to store my contact information and personal details for insurance purposes. *Your information will not be shared with any other third parties.

I confirm that the above information provided by me for this consent form is correct to the best of my knowledge, that I am over the age of consent for this procedure (i.e. 18 years old for tattoos) and that I am not currently under the influence of alcohol or drugs.

Please tick this box to confirm all of the above statements are correct.

I confirm all of the above statements are true

Signature of Client:

Date: