top of page

AWARD WINNING TATTOO ARTISTS

Lead by Two Talented Owners

AWARD WINNING TATTOO ARTISTS

Lead by Two Talented Owners

Please fill out the following health declaration form fully before services can be rendered. Submissions are valid up to 24 hours prior to your tattoo.

First Name

Last Name

Email

Age

Phone

DOB

Driver's License Number

State Issued

Address

How did you hear about us?

I acknowledge the possibility of pain or discomfort during the tattoo procedure.

If I have diabetes, epilepsy, hepatitis, hemophila, HIV-AIDS, or any other communicable disease, heart condition or take medice which thins the blood, I have advised my tattooe. I am not pregnant or nursing. I am not under the influence of drugs or alcohol.

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 influence that may interfere with the procedure. 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 employees of this shop to determine whether I might have an allergic reaction to the pigments or process 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 obtaining a new tattoo, particularly in the event that I do not take proper care and follow all aftercare instructions. I have received aftercare instructions, both verbal and written, 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 on lighter skin.

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 lighter skin.

I understand that if I have any skin treatments, laser removal, plastic surgery, or other skin altering procedures, it may result in adverse changes to my tattoo.

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 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 that I am over the age of 18 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 employees of the tattoo shop reasonably necessary to perform the procedure.

I understand that all procedures are monitered by security cameras for the security of myself and the employees of the shop and that the camera may be remotely operated for those protections.

I acknowledge that my tattooer may terminate the procedure at any time, at his/her will for any reason they see fit; including, but not limited to: influence of drugs or alcohol, excessive trauma to the skin, exhuastion, client’s inappropriate conduct in the shop, etc ... at their discretion.

I acknowledge the possibility of pain or discomfort during the tattoo procedure.

NOTE: Upload a photo of the front & back of your state issued drivers license or ID here, but you will also be required to present it in person at the time of your tattoo session.

Upload FRONT of Your Driver's License

Upload supported file (Max 15MB)

Upload BACK of Your Driver's License

Upload supported file (Max 15MB)

I acknowledge by signing this Release I have been given the full opportunity to ask any and all questions which I might have about obtaining a tattoo (hereinafter known as the “Tattooer”) and all my questions have been answered to my full and total satisfaction. I acknowledge I have been advised of the matters set forth above and I agree to these terms.

Thanks for submitting!

- FOR SHOP USE ONLY -

Please don't fill anything out below this line

Artist Name:

Date of Tattoo:

Tattoo Location:

Catalogue:

Artists Signature:

TATTOO WAIVER & CONSENT FORM

We cannot tattoo without it

© Copyright 2009 - 2024 The Black Rose Studio, Inc. I PRIVACY POLICY I Brand Management and Website by Moonhaus.com I All Rights Reserved

HOURS OF OPERATION

Monday - Saturday 1:00pm - 10:00pm

Sunday 2:00pm - 8:00pm

GET HERE QUICK

215 N Walnut Creek Dr #101,

Mansfield, TX 76063

GET ON THE VIP LIST

Enter Your Email Here

Thanks, you are now on the list

LET'S GET SOCIAL

CALL US TODAY!

bottom of page