Tattoo Release & Consent Form

Please read and complete all sections before your appointment

📋 Personal Information

Full Name *

Phone Number *

Date of Birth *

🪪 Upload Your ID Proof

Drag & drop or click to browse

JPG, PNG or PDF · Max 10 MB

Email Address

Instagram ID

Address

Emergency Contact Name *

Emergency Contact Phone *

🎨 Tattoo Information

Tattoo / Body Piercing Description *

Width (inches) *

Height (inches) *

Total Area (auto-calculated)

Enter width & height above

Is this your first tattoo? *

How did you hear about us? *

Preferred Tattoo Artist

🏥 Health Information

Please confirm all of the following * (all must be checked)

I do not have diabetes or blood-sugar related conditions.

I do not have high blood pressure.

I do not have heart conditions or take blood-thinning medications.

I am not allergic to any creams or foods.

I am not prone to fainting or dizziness.

I do not have any skin conditions (eczema, psoriasis, etc.).

Are you pregnant or breastfeeding?

📝 Consent & Agreements

Please accept all of the following * (all must be checked)

Age Confirmation

I confirm that I am 18 years of age or older and have provided valid identification.

Consent to Tattoo

I confirm that I have not consumed any drugs or alcohol in the past 24 hours and that I am fully capable of providing informed consent for the tattoo procedure.

Liability Waiver

I accept all responsibility myself and hold Rocking Needles harmless for any consequences that might steam from my decision to have any Tattoo / Piercing related work done at Rocking Needles.

Aftercare Instructions

I acknowledge that I have received and understand the aftercare instructions. I understand that proper aftercare is essential for healing.

Photography Consent

I consent to having my tattoo photographed for Rocking Needles' portfolio, social media, and promotional materials.

Digital Signature * (Type your full name — letters only)

By typing your name above, you are providing your digital signature and agreeing to all terms and conditions.