Name *

First Name

Last Name

Phone

(###)

###

####

Are you pregnant or breastfeeding?

Yes

No

Do you have any diseases or medical conditions?

Yes

No

Do you have any skin conditions? *

Yes

No

Acknowledgement and Waiver

Please select all boxes to agree

I understand that this is a permanant change to my skin and body

I understand handpoke is a manual technique and that therefore slight flaws are possible and part of the organic look of handpoke tattoos

I understand that tattoos can change over time due to a variety of factors including sun exposure, aftercare and skin type

I understand that Skye offers free touch ups

I acknowledge that Earth Temple does not offer refunds

I agree that Earth Temple does not have a way of identifying if I am allergic to the elements or ingredients that will be used for my tattoo

I understand that U need to take care of my tattoo by following the instructions given to me and that proper aftercare is vital step in the healing and protection of my tattoo

I agree to follow all aftercare instructions to prevent infection from occuring

I agree to release, forever discharge and hold harmless Earth Temple and it's artists from any and all claims, damages and legal actions arising from or connected to my tattoo

I allow my tattoo ti be photographed and shared on social media and earth temples website