Name *

First Name

Last Name

18 or older?

At Tattoo Charlie's we only tattoo ages 18 and up, we do not tattoo under 18 with parental consent. If you are under 18 we would love to see you after your birthday!

Yes

No

Is this your first tattoo?

Yes

No

Is this tattoo a new tattoo or for a cover-up?

New

Cover up

Rework Existing Tattoo

Is this tattoo covering a scar?

Yes

No

Are there any other pre-existing tattoos in the area you're wanting your new tattoo?

Please use the section below to give us as many details as possible.

Yes

No

Name *

First Name

Last Name

New Piercing or Jewelry Change

New Piercing

Jewelry Change

Phone Number

(###)

###

####

Piercer Preference

Whitney

Chad

Jordan

No Preference

Over 18 *

We follow Kentucky state guidelines for age requirements. Ages 16+ we pierce navel, cartilage, lip, and nostrils. Age 6-16 we pierce earlobes only with written notarized parental consent.

Yes

No