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KINGDOM
TATTOO
COLLECTIVE
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KTC Tattoo & Piercing Consent form
Please fill out all the information below to the best of your ability
First Name
Last Name
Email
Birthday
Age
Phone
Address
Have you been Tattooed before?
*
Required
YES
NO
Have you been Pierced before?
*
Required
YES
NO
Are you pregnant or Breastfeeding?
*
Required
YES
NO
Do you have a heart condition, epilepsy or diabetes? (If yes Please Name:)
*
Required
YES
NO
Yes Explanation:
Are you a hemophiliac (bleeder) or do you have any known conditions that may cause bleeding or hinder blood clotting? If YES please name:
*
Required
YES
NO
Yes Explanation:
Do you have any communicable diseases (HIV, AIDS, Hepatitis, (Please be honest) If yes please name:
*
Required
YES
NO
Yes Explanation:
Do you have any allergies to medication or topical solutions? (If yes please name:)
*
Required
YES
NO
Yes Explanation:
Are you under the influence of alcohol or drugs prescription or otherwise? (If yes please name:)
*
Required
YES
NO
Yes Explanation:
preferred pronoun:
She
He
They/Them
I was offered a patch test and refused (Cosmetic Tattoo's)
*
Required
YES
NO
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