Name *

First Name

Last Name

Date Of Birth *

Must be 18 years of age or older.

MM

DD

YYYY

I am 18 years of age or older *

Yes

No

Pronouns *

They/Them

She/Her

He/Him

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I do not have a fever and am not experiencing symtptoms of illness related to COVID19 *

Agree

I have not been exposed to anyone with illness or experiencing symptoms of illness related to COVID19 in the last 14 days *

Agree

I understand that Pastel is fully disposable and that I will be tattooed with new, single-use, disposable products to ensure the safest procedure possible *

Agree

I am not pregnant or nursing *

Agree

I am not intoxicated or under the influence of any substances that may inhibit, prohibit, or alter the understanding and consent to tattoo *

Agree

I acknowledge that differing results, infection, or allergic reaction is always possible *

- I understand that variations in color may occur - I understand there is no way to determine if you may be allergic to pigments or dyes used in the tattoo - I have informed my artist if I have a known allergy to any tattoo pigments - I will seek professional medical attention in the event that an infection occurs

Agree

I understand that tattoos take on average 4 weeks to heal and have agreed with the artist's aftercare instructions *

Agree

Please check if you have any of the following conditions: *

Disclosure will not prevent you from receiving a tattoo but you will have to verbally discuss these details with your artist

Diabetes

Hemophilia

History of skin diseases or sensitivities

Allergies

Epilepsy, seizures, fainting, or narcolepsy

Use blood-thinning medications

None of the mentioned above conditions

I am 18 years of age or older and am capable of consenting to this tattoo *

Agree

I consent to this tattoo, have seen the design, and checked any spelling that may be included *

Agree

I acknowledge that receiving this tattoo is my choice and my choice alone *

I understand that a tattoo is a permanent change to my appearance and no one has forced my to go through with the tattoo procedure

Agree

I forever hold Pastel and any affiliated artists harmless of any claims, damages, injury, cost or expense, legal actions including but not limited to allergic reaction, infection, or disease which may said to be connected to this tattoo *

Agree