Date of Birth:

Requested Appointment Date/Time:

Fallback Appointment Date/Time:

Reference Image 1

By checking this box, I affirm that I am at least 18 years of age, and I understand that tattooing services are not offered to minors at this location.

By checking this box, I acknowledge that this appointment request does not guarantee an appointment. I furthermore agree that an appointment will not be confirmed without a consultation beforehand and that a non-refundable deposit/ drawing fee will be collected before confirmation.

I consent to receive electronic communications in relation to requested tattoo service (text and email).