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PERMANENT COSMETICS/TATTOO CONSENT AND RELEASE FORM
I acknowledge by signing this release form that I have been given the full opportunity to ask any and all questions I might have about obtaining a tattoo from Tiffany Williams operating under the business name Boundaries. I acknowledge that all my questions have been answered to my full and total satisfaction. I specifically acknowledge that I have been advised of the facts and matters set forth below, and I agree as follows:
I agree to release and forever discharge and hold harmless Tiffany Williams, Boundaries, and all associated entities, agents, officers, and representatives from any and all claims, damages, or legal actions arising from or connected in any way with my tattoo or the procedures and conduct used to apply my tattoo and any tattoos applied in the future. *
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I acknowledge that the Venue or Business of event are not involved in or associated with Boundaries' tattoo operations, services, or liabilities, and I release them from any and all liability related to my tattoo procedure. *
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I am not under the influence of alcohol or drugs. *
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I do not have acne, freckles, moles, or sunburn in the area to be tattooed that might be agitated by the tattoo process. *
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I have looked over my design, checked the spelling if applicable, and give my full consent to the application of my tattoo. *
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I acknowledge that I am not pregnant. *
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I acknowledge that I am free of communicable disease.I acknowledge that I am not pregnant. *
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I have truthfully represented to the associates, agents, and representatives of Tiffany Williams that I am over 18 years of age. *
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I acknowledge that it is not reasonably possible for the associates, agents, or representatives of Tiffany Williams to determine whether I might have an allergic reaction to the dyes, pigments, or processes used in my tattoo. *
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I acknowledge that infection is always possible as a result of obtaining a tattoo, particularly if I do not take proper care of my tattoo. *
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I acknowledge receipt of written instructions advising me of proper care of my tattoo, and recognize the necessity of following those instructions. *
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I acknowledge that variations in color and design may exist between any tattoos selected by me and as applied to my body. *
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I acknowledge that tattooing is a permanent change to my appearance, and no representations have been made as to the ability to change or remove it later. *
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I acknowledge that obtaining my tattoo is my choice alone, and I consent to the application and any actions necessary to perform the tattoo procedure. *
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I acknowledge that tattoo inks, dyes, and pigments have not been approved by the FDA, and the health consequences are unknown. *
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I acknowledge there is a chance I may feel lightheaded or dizzy during or after being tattooed, and I will notify the practitioner if this occurs. *
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I agree to follow all instructions for the care of my tattoo, and any touch-ups due to my negligence will be done at my expense. *
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By typing my full name below, I digitally sign and affirm that I have been fully informed of all risks and still wish to proceed with the tattoo application.

I have been fully informed of the risks of tattooing, including but not limited to infection, scarring, difficulties in detecting melanoma, and allergic reactions to tattoo pigments, latex gloves, and antibiotics. Having been informed of the potential risks associated with getting a tattoo, I still wish to proceed with tattoo application and assume any and all risks that may arise from tattooing. *
Client Name *
Procedure Description *
Todays Date *
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