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The Kingdom Tattoos and Piercing Consent Form
First name
Last name
Email
Phone
Address
Birthday
Month
Day
Year
*
Placement of Tattoo Or Piercing
Medical Disclosure: Do you have any of the following conditions( Check all that Apply
*
Diabetes
yes
no
*
Heart Condition
yes
no
*
Blood Disorders
yes
no
*
Skin Condition
yes
no
*
Allergies
yes
no
*
Epilepsy
yes
no
*
Other
yes
no
Other
*
Are you Currently Pregnate or Missing?
yes
no
*
Are you under the influence of drugs or alcohol
yes
no
*
Are you currently taking medications? If yes please List them
yes
no
Other
*
Are you currently taking medications? If yes please List them
yes
no
Other
Parent/ Legal guardian For Clients Under 18
Parent/Guardian's Full Name
Relationship To Minor
*
Parent or Guardian Phone #
*
Todays Date
Month
Day
Year
Parent Or Guardian's Signature
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Clients and Artists Signatures
*
Client Signature
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Date
Month
Day
Year
Artists Signature
Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.
Date
Month
Day
Year
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Kingdom Tattoo and Piercing Concent Form
The Kingdom Tattoos
Tattoo & Piercing Consent Form
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