To my knowledge, I do not have any physical,
mental, or medical impairment or disability which might affect my well
being as a direct or indirect result of my decision to have any tattoo-related
work done at this time.
Being of sound mind, I hereby release any and all persons
representing “Unusual Expressions Tattoo & Piercing”, (also known as
My Tattoo & Piercing Place) from all responsibility.I
accept any and all responsibility myself for any consequences that might
stem from my decision to have or allow my child to have any
tattoo – piercing related work done at “Unusual Expressions
Tattoo & Piercing”.
Minor's Full Name: _________________________
Address: ______________________________________
City: _________________________________________
State: ________________________________________
Zipcode:______________
Phone: _________________________
Minor's
Signature: ____________________________
Parents signature:
_____________________________
Note: this form is not valid unless valid identification is copied on
the back of this sheet.
If the minor does not have valid identification the consenting
parent or guardian excepts all responsibility!
Notary Date:___________________