CONSENT FORM

Name:

Surname:

Street and house number:

City:

Zip code:

Phone number:

E-mail:

Date of birth:

Full name of parent/guardian:

Document number:

I have informed the tattoo artist about my health situation and medical history that may apply to having a tattoo applied.

Yes

I have been informed of the risks and possible complications and I understand this information.

Yes

The aftercare procedure has been clearly explained to me and I understand what actions I need to perform and what precautions I need to take. I was presented with my own copy of the aftercare procedure.

Yyes

I confirm that I have given the above information and statements to the best of my knowledge.

Yes

I confirm that I am of the age at which I can give permission for this treatment.

Yes

I confirm that I am not currently under the influence of alcohol or drugs or other substances that could affect my experience, free will and judgment.

Yes

I consent to the tattooing being carried out as described by

Britt van der Linden

Nadine Lemak

I have read the attachment to this consent form.

Yes

I confirm that the tattoo artist may keep this consent form for administration purposes.

Yes

I am aware of and accept the risks and possible complications associated with being tattooed.

Yes

Signature

Signature of parent/guardian confirming consent

Date:

Please complete read this information and fill in the form below prior to the tattoo treatment

Consent form