Declaration of Consent

Tattoo Customer Information & Advice

Personal Data

First name, Last name

Date of birth

Street, Nr.

Email address

Postcode, City

Current occupation

Phone number

Personal Details

Please answer the following questions truthfully. Incorrect information can lead ot health risks. Health and personal restrictions, chronic illnesses or heavy drug consumption can lead to rejection of the tattoo.

Did you have an appointment or did you use our walk-in? AppointmenbtWalk-In Which of our studios are you in? CharlottenburgTempelhof Do you suffer fromillnesses and/or allergies? YesNo

If yes, which ones?

Have you taken any medication in the last 24 hours? YesNo

If so, which one/s?

Have you consumed alcohol in the last 24 hours? YesNo Have you had a good night's sleep, eaten enough and feel fit altogether? YesNo Could you be pregnant or are you planning a pregnancy? YesNo

Information

TATATTOO IS FOREVER

There is currently no known procedure that guarantees a tattoo to disappear without atrace. Health risks are completely unexplored.

TATTOOS CAN LEAD TO RESTRICTIONS

Although tattoos are becoming more and more popular, they are by no means gladly accepted everywhere. Please consider that when choosing your dreamjob.

TEMPLATE AND RESULT

The actual tattoo will always look different from a drawing on paper. Deviations may occur, depending on skin type and colour. In addition, the tattooist may have to adapt the motif anatomically in shape, size and colour. An exact preview of the result can never be simulated.

ALLERGIES,INFECTIONS, INFLAMMATION

Complications may occur despite adherence to the highest possible hygiene standards. Allergic and inflammatory reactions are possible. The risk of infection cannot be ruled out either. Proper wound care is also part of prevention. If complications resulting from a tattoo have to be treated by a doctor, it is possible that your health insurance company will not cover the costs completely. A so-called "Blow-Out" may occur, a complication that is harmless to health: The colour in theskin, similar to ink on blotting paper, "bleeds out". This can never be ruled out and depends on the connective tissue. It is not possible for the tattooist to exclude this risk in advance.

Possible complications after getting a tattoo

Even when properlyexecuted, a tattoo maybear the riskof the following, unwanted side effects:

pain, discomfort
circulatory problems
allergies
wound healing disorders
haemorrhage, hematoma
permanent scarring
infections
tissue necrosis

vascular injuries
nerve injury
temporary numbness
permanent numbness
rejection reaction
thrombosis
embolism
neurological deficits

inflammation (redness, swelling, lymph node swelling)
game meat, keloid, abscesses

I have read and understood Yes

Information about the tattoo

Please describe your desired tattoo and where you want it:

Required signatures

All my questions about my desired tattoo were answered and the process explained in detail.The tattoo is according to §223 Abs. 1 StGB an intervention in the physical integrity and thus a bodily injury. By my signature under this declaration of consent, I expressly agree to the tattoo and it does not apply to the illegality of bodily injury.I was informed that Autark - das Tattoostudio in Deutschland.® with the placing of order is not in any liability position. Should it come to legal measures - on whatever basis - the freelancer (tattoo artist, piercer, etc.) is exclusively liable. With my signature I assure that all information is true.

I have read and understood Ja Date Your information will be forwarded to Autark Tattoo Studio, who will contact you via email around your tattoo or piercing appointment. Signature of client

We will take photographs of the completed work. The customer here by explicitly agrees that these photographs may be used for purposes beyond those permitted by Art. 6paragraph 1(f) EU GDPR for the purpose of external presentation on our website, on our social media channels or on advertising banners. In addition,we will collect health data in this declaration of consent so that wecan decide whether the execution of the contract is possible without endangering your health and without impairing the result of our work. Therefore, without these data collection the contract will not be carried out by us. These data are special data according to Art. 9 EUGDPR. Herewith, you give yourexpress consent to the collection ofsaid data. We wil not pass onthese data to third parties, and they willbe stored byus for a period of 10 years. Afterwards. the declarations of consent will be deleted. This consent can be revoked at any time (Art. 7 para. 3 EU GDPR). After the revocation, we are not allowed to use andprocess the photographs collected and/or used with the consent. The health data collected will be kept until the end of the retention period, as ti is legitimate to process them until the time of revocation.

Date Signature of client

Special remarks

(to be filled in by the tattooist)

Details of the tattooist

(to be filed in by the tattooist).

The tattoo can be created as desired YesNo Change according to customer's request, after verbal arrangement: Date Name of tattooist Signature of tattooist