Consent & Waiver Release | Cora Mylene Tattoos

Consent & Waiver Release for Tattoo

Cora Mylene Tattoos

Your Information

First Name *

Last Name *

Today's Date *

Date of Birth *

Address

Address *

City *

State *

Country

Postal code *

Phone *

NOTE: you will receive a text to verify your phone number; this ensures you receive aftercare instructions via text message after your appointment

Email *

License Number *

Please enter your Driver's License or other valid ID number

Please Initial Below

Color/design variations *

Variations may exist between the chosen design and the final tattoo; darker skin tones may show colors less brightly.

Age & consent *

I am over 18, obtaining the tattoo by my choice, and consent to any reasonable actions by shop staff necessary to perform the procedure.

Future skin treatments *

Skin treatments (laser hair removal, plastic surgery, etc.) may cause adverse changes to my tattoo.

Permanence & impairments *

A tattoo is a permanent change to my appearance. No representations have been made about later removal or alteration. I have no impairment that might affect my well-being due to this decision.

Medical conditions & substances *

If I have any condition that might affect healing, I will advise my tattooer. I am not pregnant or nursing and am not under the influence of alcohol or drugs.

Skin issues *

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 the tattoo. If I have any infection or rash anywhere on my body, I will advise my tattooer.

Allergic reaction risk *

I accept that representatives and employees of this tattoo shop cannot determine whether I might have an allergic reaction to pigments or processes used in my tattoo and I accept that such a reaction is possible

Infection risk & aftercare *

Infection is always possible. I have received aftercare instructions and will follow them. Any touch-up work needed due to my own negligence will be at my own expense.

Consent Agreements

Do you give consent for this tattoo? *

By checking this box, you agree that you have read and agree with the terms of the waiver and that the information you provided is accurate. You furthermore agree that your submission of this form, via the ‘Agree & Complete’ button, shall constitute the execution of this document in exactly the same manner as if you had signed, by hand, a paper version of this agreement.

I Consent to Receive SMS Notifications, Alerts, and Occasional Marketing Communication from Cora Mylene Tattoos. Message frequency varies. Message & data rates may apply. Text HELP to (979) 561-7002 for assistance. You can reply STOP to unsubscribe at any time

Photo release *

Yes

I give permission for my photos to be used for marketing and understand they may appear in print or online.

Your Signature *

Clear

Please sign here.

Tattoo Info: Please Hand This to Cora To Complete

Colors *

NOTE: please ask Cora to enter this information

Placement *

Tattooer Signature *

Clear

IMPORTANT: please hand this over to Cora for final review and signature before completing.