1Service2Identification3Client Info4Questions5Client Review6Signature7Client Complete Service(Required) Piercing Tattoo Choose a service to get started.Tattoo Artist(Required)Select an ArtistJustinStella SinTattoo Description(Required)Tattoo Body Location(Required)Tattoo Cost(Required)Hourly Cost is hourlyPiercer(Required)Select an ArtistKerriLauraMattTabithaPiercing(Required)Piercing Cost(Required)Jewelry(Required)Jewelry Cost(Required)Deposit(Required)IdentificationInformation for the person getting a $$SERVICE and their identificationLegal Name(Required) First Middle Last Birthdate(Required) MM slash DD slash YYYY Minor Identification(Required)Accepted file types: jpg, png, Max. file size: 512 MB. Photo of minor identification approved by counter personGuardianship Paperwork (Optional)Accepted file types: jpg, png, Max. file size: 512 MB. Photo of guardianship paperwork approved by counter personClient ID(Required)Accepted file types: jpg, png, Max. file size: 512 MB. Photo of the ID of the person completing this formClient ID Number(Required)Issued number from the document used above Client InfoTell us about $$NAME getting a $$SERVICEChosen Name for $$NAME (optional)Mailing Address(Required) Street Address Apartment, Unit, etc. City State ZIP AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone Number (optional)Your Email Address Guardian's Legal Name(Required) First Middle Last Relationship to Minor(Required)Choose your relationshipNatural Guardian (birth parent)Legal Parent via AdoptionOtherOther Relationship to Minor(Required) QuestionaireHave we worked on $$NAME before?(Required) Yes No What brought you to Imperial?(Required)Eaten Recently?(Required)Has $$NAME eaten in the past 4hrs? It's a good idea to increase the blood sugar levels. It's okay if $$NAME hasn't, we need to know for their safety. Yes No Bloodborne Pathogens?(Required)Does $$NAME have any bloodborne pathogens, transmittable diseases or recent illnesses? It's okay if they do, we need to know for ours and their safety. Yes No Known Allergies(Required)Let us know of any allergies $$NAME has for their safety. Type “none” if $$NAME has no known allergies.Photography?(Required)We are proud of our work and often like to share photos on social media or print media. Do we have permission to use photographs of the work we do on $$NAME? Yes No ReviewPlease review your information for accuracy. If anything is wrong, please go back and edit before proceeding to sign.Details Confirm(Required) I confirmI confirm that the information provided above is accurate and complete. I am providing this consent voluntarily, of my own free will, and am not under the influence of alcohol or any substance that would impair my judgment. I understand that this form is legally binding. General ReleaseI understand that piercings carry risks including infection, scarring, keloids, and allergic reactions. I accept these risks and choose to proceed.I understand this $$SERVICE will permanently alter my appearance and may not be fully reversible, even after removal.I have had the opportunity to ask questions about the procedure, and all my questions have been answered satisfactorily.I am responsible for the accuracy and meaning of any text or symbols I provide or select. Imperial Body Art is not responsible for spelling or translation errors.I understand that the final result may vary slightly from the design, and that tattoo colors and clarity will naturally fade over time.I release Imperial Body Art and the artist from all liability for any injury, damages, or claims arising from this service, including those caused by negligence.General Release(Required) I agree to the release termsMedical ReleaseI understand that Imperial Body Art staff are not medical professionals. This $$SERVICE is a body modification, not a medical procedure. Any questions about medical interactions should be directed to a licensed medical professional.I confirm that I do not have diabetes, epilepsy, hemophilia, heart conditions, or take blood thinning medication. I am not an organ or bone marrow transplant recipient (unless taking preventive antibiotics). I am not pregnant or nursing. I do not have a mental impairment affecting my judgment, nor any other medical condition that may interfere with this procedure or healing.Medical Release(Required) I agree to the medical release termsAftercareI will receive aftercare instructions after my appointment and via email. I am responsible for following these instructions and contacting the shop if I have questions. I understand that failure to follow aftercare can result in infection or other complications.I understand that touch-up work needed due to my own negligence will be done at my own expense.I am responsible for keeping threaded jewelry ends tight. I understand that ends can loosen or break from normal wear or manufacturer defect. Any replacement of lost jewelry will be at my own expense.Aftercare Confirmation(Required) I confirm aftercare instructionsYour Signature(Required)By signing, I attest that all information is accurate.Your Signature Typed(Required) $$NAME is ready to goThank you for your patience! Please return the tablet to the counter person and let them know you’ve completed the form. You’ll be called back as soon as $$ARTIST is ready for you. Artist Signature(Required)
