CONSENT TO TATTOO PROCEDURE      Tokyo, …….../…../………


NAME ……………………………………………..………, DOB……./……./……  ……………………….
ADDRESS………………………………………………………………….…………………………………..
PH…………………………………………..

I acknowledge by signing this agreement that I have been given the full opportunity to ask any and all questions which I might have about the obtaining of a tattoo and that all of my questions have been answered to my full satisfaction.
I specifically acknowledge I have been advised of the facts and matters set forth below and I agree as follows:
• If I have any condition that might affect the healing of this tattoo, I will advise my tattooer.
I am not pregnant or nursing. I am not under the influence of alcohol or drugs.
• I do not have medical or skin conditions such as but not limited to: acne, scarring (Keloid) eczema, psoriasis, freckles, moles or sunburn in the area to be tattooed that may interfere with said tattoo. If I have any type of infection or rash anywhere on my body, I will advise my tattooer.
• I acknowledge it is not reasonably possible for the representatives and associates of this tattoo studio to determine whether I might have an allergic reaction to the pigments or processes used in my tattoo, and I agree to accept the risk that such a reaction is possible.
• I acknowledge that infection is always possible as a result of the obtaining of a tattoo, particularly in the event that I do not take proper care of my tattoo.
I have received aftercare instructions (as also provided on the webpage), and I agree to follow them while my tattoo is healing. I agree that any touch-up work needed, due to my own negligence, will be done at my own expense.
• I realize that variations in color and design may exist between any tattoo as selected by me and as ultimately applied to my body. I understand that if my skin color is dark, the colors will not appear as bright as they do on light skin.
• 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.
• I acknowledge that I understand the “tattooer” is practicing his/her art and I allow and agree by providing the means “of expression” irrespective of any jurisdictional regulations if any.
To my knowledge, I do not have a physical, mental or medical impairment or disability which might affect my well being as a direct or indirect result of my decision to have a tattoo.
• I acknowledge I am over the age of eighteen and that I have truthfully represented to my tattooer that the obtaining of a tattoo is by my choice alone.
I consent to the application of the tattoo and to any actions or conduct of the representatives and associates of the tattoo studio reasonably necessary to perform the tattoo procedure.



CLIENT: ………………………………………...
DATE


TATTOOER: ……………………………………..
DATE