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**I understand that"GYPSY LANTERN TATTOO PARLOR"does not guarantee any tattoo below the shoe <br /> line. <br /> Signature: <br /> Name: <br /> Address: <br /> City State: ZIP: <br /> Drivers License Number or I.D.: <br /> D.O.B.: Age: Today's date: <br /> ***************************DO NOT WRITE BELOW THIS LINE***************************** <br /> Design Placement <br /> Artist Price <br /> Touch Up New Tattoo Repair Cover Care Info: <br /> Verbally Written Remarks: <br /> NOTE:Signs and Symptoms of infection include(but are not limited to),Swelling, Prolonged Redness, <br /> Odor and/or puss <br /> **See Doctor if conditions worsen** <br />