Tattoo consent form

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Please select the artist your are booked in with.
Date / Time
Participant's Name
Please type your full name as on the booking, if you made the booking for someone else please use their name.
Checkboxes
I hereby declare I am of legal age (18+) and have valid proof of age when asked. If you look under the age of 25 will ask proof of age documents.
Booking made under name
If the booking has been made by you for someone else.
Email address
Address
Name and address of the client:
How Will My Information Be Used?
The information that you provide about you and your family will be used to [describe the purpose of collecting the information e.g. gain an insight into services and what is important to families].
Consent
I have read the information above and have had an opportunity to ask questions about the [research / activity] and how my information will be used. I understand the purpose of the [research /activity] and what my participation involves. I agree to take part in [describe what involvement the individual will have e.g. an interview] and for the information I provide to be shared with the [area] Partnership agencies and this in turn allows services that I use to share information about me and my family for the purpose of this [research / activity]. I understand that I need to inform the other members of my family that I have given consent which will allow them to opt out if they wish. I understand that anonymized [information / research] about me and my family may be published within the [project report / relevant document], which may be published online and that published material from this [project / report] may be used and distributed for training and service design and development. I know that my participation is voluntary and that I can choose to withdraw from the research at any point.
Clear Signature