Waiver | nerdyneedletattoos

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Photo of I.D.

Tattoo design and placement

Name

Preferred Name & Pronouns

Date of birth

Month

Day

Year

Email

Address

Phone

Emergency Contact

Phone

Miliary Branch and Rank

Verify all statements

I am NOT pregnant or nursing

I am NOT under the influence of Alcohol or Controlled Substances

I do NOT have any allergies to dyes, fragrances, or adhesives

I consent to photographic record (for advertising)

Signature(Required)

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I acknowledge by signing this agreement that I have been given the full opportunity to ask all questions which I might have about the procedure.

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