Birthday*

Photo ID Expiry Date*

Photo ID State*

How did you hear about Elle?

I release all rights to any photographs taken of me and the tattoo and give consent in advance to their reproduction in print or electronic form. (If your answer is no, please advise Elle NOT to take any pictures of you or your completed tattoo!)*

If I have any health conditions that might affect the healing of this tattoo, I will advise my tattooer. I am not pregnant or nursing. I am not under the influence of alcohol or drugs. I do not have a mental impairment that may affect my judgement. *

I understand a tattoo is a permanent change to my appearance and can only be removed by laser or surgical means, which can be disfiguring and/or costly, and which in all likelihood will not result in the restoration of my skin to its original appearance. *

I realize that variations in colour and design may exist between any tattoo as selected by me and as ultimately applied to my body. *

I also understand that over time, the colors and the clarity of my tattoo will fade due to unprotected exposure to the sun and the naturally occurring dispersion of pigment under the skin. *

I acknowledge it is not reasonably possible for Elle to determine whether I might have an allergic reaction to the pigments or processes used in my tattoo, and I agree to accept the risk that such a reaction is possible. *

I voluntarily assume any potential risks associated with the use of the numbing cream, whether or not it is supplied by Elle. I understand it is my responsibility to perform a patch test, and consult with a medical professional regarding side affects.*

I agree that it is my responsibility to review the tattoo design for any errors and I must approve any spelling before tattooing commences. *

If I have chosen a finger/hand/palm/foot/mastoid or ear tattoo, I have been informed these areas are physiologically predisposed to dropping out, fading and/or blurring, therefore any touch ups to these areas are at my own expense. *

I acknowledge that infection is always possible as a result of obtaining a tattoo, particularly in the event that I do not take proper care of my tattoo. I have received aftercare instructions, and I agree to follow them while my tattoo is healing.*

I agree that any touch-up work that is needed, due to my own negligence, will be done at my own expense. *

I am over the age of eighteen 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 Elle reasonably necessary to perform it.*

I acknowledge by signing this agreement that I have been given the full opportunity to ask any and all questions which I might have about the obtaining of a tattoo and that all of my questions have been answered to my full satisfaction. *