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Have you suffered from any of the following please tick if applicable
Please tick if applicable
If you answer yes to any of the above you should consult a G.P before proceeding.

  • I acknowledge that by filling in this form that I have been given full opportunity to ask any questions which i might have about obtaining a tattoo or piercing and that all of my questions have been answered to my satisfaction.

  • I acknowledge that it is not reasonably possible to determine whether I might have an allergic reaction to the pigments or the process used in my tattoo or piercing and I agree to accept the risk that such is possible. I agree to indemnity and keep indemnified the supplier / studio / tattooist or piercer against all claims and proceedings in respect of any personal injury or damage arising out out of, or as a result of, the supply or service 

  • I acknowledge that infection is always possible as a result of obtaining a tattoo or a piercing, particularly in the event that i do not take proper care of my tattoo and piercing and I agree to follow all instructions concerning the proper care of my tattoo and piercing while it heals.

  • I fully understand that I must be over 18 years of age or over to be tattooed or pierced. I acknowledge that I have truthfully represented to the employees of the Stolen Magpie tattoo studio. I have today given my correct names age and address.

  • This is certify that I, the above named and undersigned, do give my permission to be tattooed / pierced and i am fully aware of the process involved and understand the importance of a daily aftercare procedure.

Proof of Age
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I am under 18 years of age and accompanied by my parent / guardian

Name of Artist / Piercer

The Stolen Magpie Tattoo, Studio 282 Portswood Road, Southampton, SO172TD

THE STOLEN MAGPIE CONSENT FORM
Where there is no history of any allergic reaction we would still advise spot testing of tattoo ink
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