Parental Consent Form - Tattoo

I, _______________________ (print parent's name), certify that I am the parent or legal guardian of________________________ (print child's name). I am giving my consent for the above named child to be tattooed by Wild Side Tattoo. I certify that the child is not pregnant, not taking any prescription drug which might adversely affect the procedure (such as anti-coagulants), and does not have any medical conditions which might adversely affect the procedure.

I understand that my child will be given care instructions, and that it is necessary that he/she follow all the instructions to insure the proper healing of the tattoo. I understand that deviating from these instructions can result in improper healing, infection, and possible scarring.

In addition, I release Wild Side Tattoo and any related parties from any liability which may arise as a result of my child being tattooed.

Print Parents Name: ___________________________________ Date: _____________

Address: _____________________________________________ Ph #: _____________

Child's Date of Birth: _______________________________ Race & Sex: __________

Description of Tattoo: ________________________________________________________

Please List Any Allergies (particularly to medication): ________________________________________________________________________

Parent's Signature: ______________________________________________________
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