02 / Please read carefully
Tattoo consent release form
I, [print name] acknowledge by signing this release form that I have been given the full opportunity to ask any and all questions I might have about obtaining a tattoo from Derek Dao. I acknowledge that all my questions have been answered to my full and total satisfaction. I specifically acknowledge that I have been advised of the facts and matter set forth below and I agree as follows.
Check each statement only if it is true for you. If a statement does not apply, speak with Derek before proceeding.
I, [print name] have been fully informed of the risks involved with tattooing including but not limited to; infection, scarring, difficulties in detecting melanoma and allergic reactions to tattoo pigments, latex gloves and antibiotics. Having been informed of the potential risks associated with getting a tattoo, I still give my full consent to proceed with the tattoo application and I will assume any and all risks that may arise from tattooing.