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Mama Tried Tattoo Parlour
Permit #103533
1052 Bardstown Road, Louisville, KY 40204
502-758-8280

I acknowledge by signing this agreement that I have been given the full opportunity to ask any and all questions I might have about the obtaining of a tattoo and that all of my questions have been answered to my full and total satisfaction. I specifically acknowledge that I have read this document and have been advised of the facts set forth below, and I agree as follows:


I am not pregnant or nursing.

I am not under the influence of alcohol or drugs. 

I do not have medical or skin conditions in the area to be tattooed that may interfere with said tattoo.

I have not ingested an anticoagulant that thins the blood or interferes with blood clotting in the past twenty-four (24) hours.

I am not on antibiotics, steroids, or any medication that may impede the tattoo's application and/or healing.

I have not put any numbing creams, ointments, or any other substance that may interfere with the safe application of a tattoo onto my skin prior to my appointment.

I acknowledge that it is not reasonably possible for the tattoo artist to be able to determine whether I might have an allergic reaction to the pigments or processes used in my tattoo, and I agree to accept the risk that such reaction is possible.

I acknowledge that infection is always possible as a result of the obtaining of a tattoo, particularly in the event that I do not take proper care of my tattoo, and I agree to follow all instructions concerning care of my own tattoo while it is healing. I have been given these instructions, and I understand and will follow them.

I agree that any touch up work needed that is due to my own negligence will be done at my expense.

If I am being tattooed by an apprentice, I am aware of that and have been given the full opportunity to ask any and all questions which I might have about the obtaining of a tattoo and that all of my questions have been answered to my full satisfaction. I have been informed about the experience of the apprentice, and I understand that there is the possibility of technical imperfections. 

I realize that variations in color and design may exist between any tattoo selected by me and as ultimately applied to my body.

If my tattoo is a symbol or word(s) the tattoo artist, owner of the business, and the studio as a whole are not responsible for what it may or may not mean. It is my responsibility to proofread any and all writing before the tattoo is applied.

I acknowledge that a tattoo is a permanent change to my appearance and that no representations have been made to me as to the ability to later change or remove my tattoo.

To my knowledge, I do not have any physical, mental, or medical impairment or disability which might affect my well being as a direct or indirect result of my decision to have any tattoo related work done at this time.

I acknowledge that I have truthfully represented with a state or federally issued photo ID that I am 18 years of age or older, and that this information is true and correct.

I acknowledge that obtaining a tattoo is by my choice alone, and I consent to the application of the tattoo and to any actions or conduct of the tattoo artist reasonably necessary to perform the tattoo procedure.

I release all rights to any photographs or video taken, and give my complete advance consent for their reproduction in any print or electronic form or exhibition in any venue.

I agree to release and hold harmless the tattoo artist, business, and business owner from any and all claims, damages, or legal actions arising from or connected in any way with my tattoo or the procedures and conduct used to apply my tattoo.

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