POCK_STUDIOS_CONSENT.EXE

1 CLIENT INFORMATION ✕

First Name Last Name Date of Birth Phone Email Street Address Government ID Type ID / License Number Emergency Contact Name Emergency Contact Phone

2 TATTOO DETAILS ✕

Artist Body Placement Cover-up / Rework?

3 MEDICAL SCREENING ✕

▸ Check any that apply. This helps your artist keep you safe — nothing here disqualifies you automatically.

Current medications Anything else your artist should know

4 ACKNOWLEDGMENT & RELEASE ✕

▸ Read each statement and check the box to confirm. All are required.

I am 18 years of age or older and the government-issued ID I have presented is valid and belongs to me. I am not under the influence of alcohol or drugs at this time. I understand a tattoo is permanent, that removal is difficult, costly, and may not be complete, and I accept this. I understand the risks, which may include infection, allergic reaction, swelling, scarring, and a result that differs from my expectation. I have disclosed all medical conditions and medications truthfully and to the best of my knowledge. I have reviewed and approved the design, spelling, size, color, and placement before work begins. I accept full responsibility for aftercare and understand healing and final appearance depend on how I care for the tattoo. I release and hold harmless Pock Studios LLC, its owners, employees, and artists from any claim arising from this procedure, except in the case of gross negligence.

5 PHOTO OF YOUR ID ✕

▸ UPLOAD_ID.EXE✕

▸ TAP TO PHOTOGRAPH ID

Camera opens on phones · or choose a file

6 SIGNATURE ✕

▸ By signing below I confirm everything on this form is true and I consent to be tattooed.

▸ SIGNATURE.BMP

✕

Type your full legal name Date

Electronic signature notice: By drawing your signature and submitting this form you agree, under the U.S. ESIGN Act and applicable state law (UETA), that your electronic signature is the legal equivalent of a handwritten one. A timestamped copy of this record, your signature, and the photo of your ID are retained by Pock Studios LLC.

CONSENT TO TATTOO

SAVING RECORD…

YOU'RE ALL SET