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Keepsake Tattoo 

Please fill out the following form
in order to participate in our activity.

birth certificate

If you are under the age of 18, please upload a copy of your birth certificate along with a photo ID of the parent signing for you.  

Upload your ID
Step 1: Click choose file below
Step 2: click take a photo or upload photo from device

Upload your ID
Please click on which apply and elaborate briefly in the box below

By signing this form I agree to the following:

I agree to follow all verbal and/or written instructions concerning the care of my tattoo. Any touch-up work that needs to be done due to My own negligence will be at my own expense. If my skin is dark, it will affect the intensity and color of the tattoo. I do not have Any mental, physical, or medical impairment which may affect my judgment or my well-being as a direct or indirect result of my Decision to have tattoo work performed at this time. Keepsake Tattoo and its employees should not be held responsible for any claims, damages, actions, judgments, litigation costs, attorney’s fees, and all other cost expenses which might arise from my decision to have a tattoo work done at this time

By signing this form, I hereby certify that, to the best of my knowledge, the information I have provided is correct. I certify that I am at least 18 years of age and will provide legal identification to be photocopied and attached to this form. I certify that all questions have been answered to my satisfaction. By submitting this form I release all rights to any photographs/videos taken of me and my tattoos. I also give consent in advance to their reproduction in prints and social media.

Sign with your finger.

Thanks for submitting!

BOARD OF HEALTH - BODY ART DISCLOSURE STATEMENTS

THIS STATEMENT IS TO BE GIVEN TO ALL BODY ART CLIENTS, AND IS TO BE SIGNED BY THE CLIENT, PRIOR TO PERFORMING ANY BODY ART PROCEDURE

TATTOO DISCLOSURE STATEMENT

As with any invasive procedure, tattooing may involve possible health risks. These risks may include: Pain, bleeding, swelling, infection scarring of the area, and nerve damage.

Pain, bleeding, swelling, infection scarring of the area, and nerve damage. Un-sterile equipment and needles can spread infectious diseases; it is extremely important to be sure that all equipment is clean and sanitary before a use. Tattoos and permanent makeup are not easily removed and, in some cases, may cause permanent discoloration. Think carefully before getting a tattoo. There is also the possibility of an allergic reaction. The inks or dyes used for tattoos are color additives. Currently, no color additives have been approved by FDA for tattoos, including those used in permanent makeup. Blood donations cannot be made for a year after getting a tattoo or permanent makeup.

THE BODY ART PRACTITIONER SHOULD

Properly and thoroughly cleanse the area before the procedure. Use sterilized equipment. Use sterile techniques. Provide information on the aftercare of the area receiving body art.

HEALTH HISTORY AND INFORMED CONSENT

The following conditions may increase health risks associated with receiving body art:

  1. diabetes

  2. hemophilia (bleeding)

  3. skin diseases, lesions, or skin sensitivities to soaps, disinfectants etc.

  4. history of allergies or adverse reactions to pigments, dyes, or other sensitivities

  5. history of epilepsy, seizures, fainting, or narcolepsy;

  6. use of medications such as anticoagulants. (such as coumadin) which thin the blood and/or interfere with blood clotting; and

  7. hepatitis or HIV infection

Deposits are nonrefundable, we reserve the right to pass on any design and person.  All appointments must be made through the shop and deposits must be taken upon the agreement of a convenient time and date.  

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