Tattoo Waiver for TealPLEASE NOTE THIS IS A TATTOO WAIVER FORM. THIS IS TO BE COMPLETED JUST BEFORE SITTING FOR YOUR APPOINTMENT. FOR ANY ENQUIRIES, PLEASE HEAD DIRECTLY TO TEAL’S BIO PAGE. Name of Premises: Lemon Head Tattoos Ltd Address of Premises: Unit 1, ABC Wharf, 165 King St, Norwich NR1 1QH Name of Practitioner: Teal Barnes Full Name of Client: Date of Appointment: Address of Client: Telephone Number of Client: Email Address of Client: Date of birth and age: 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 ConsentPlease 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/tattoo-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 trueSignature of Client: Date:
