Red River - TATTOO CONSENT

TRUE BLUE 1 - INFORMED CONSENT

True Blue - Red River
I specifically acknowledge that I have been advised of the facts and matter set forth below and I agree as follows:(Please initial on each line next to the letters A-G)
[A]. I acknowledge that I have truthfully represented to the employees, or agents of TRUE BLUE TATTOO, LLC that I am 18 years of age or older. If I have shown false identification, I take full responsibility for my actions and forever release all employees, agents, and representatives of TRUE BLUE TATTOO, LLC Please note, MINORS using fake I.D. will be PROSECUTED. Initial below:*
[B]. I acknowledge that the obtaining of a tattoo is by my choice alone. I am not under the influence of drugs or alcohol, I am in good health and have no medical conditions which might cause problems. I also consent to the application of the tattoo, and to any actions or conduct of employees, agents, and representatives of TRUE BLUE TATTOO, LLC, reasonably required to perform the tattooing procedure. I also acknowledge that the tattoo is permanent, could cause pain or discomfort, may become infected if not properly cared for. Initial below:*
[C]. I acknowledge that the methods of sterilization used by this studio and their agents, is in full accordance with the sterilization procedures and aseptic techniques of the Texas Department of Health. Initial below:*
[D]. To my knowledge, I am free from any infection or contagious disease in a communicable stage, including but not limited to: rashes, skin lesions, boils, and blood-borne diseases, such as hepatitis and HIV. Initial below:*
[E]. I understand that if I have any disorders including but not specifically limited to, epilepsy, hemophilia, diabetes, heart disease, or pregnancy, that I should not have tattooing done at this time and should seek the advice of a physician before doing so. Notwithstanding the warning, I will hold myself liable if I decide to do so. Initial below:*
[F]. I acknowledge that I have received, read, and understand the written aftercare instructions, I agree to follow aftercare instructions of my new tattoo as described below and provided orally by the artist. Remove the bandage between 2 – 5 hours, and do not re bandage. Gently wash the tattoo to remove any ointment, rinse, and pat dry. Wash the tattoo daily with liquid antibacterial soap. Apply a thin coat of antibiotic ointment such as A&D ointment. Rub in until tattoo is completely moisturized, blotting off any excess with a tissue. This should be done daily for 5 days. After 5 days, use a quality unscented lotion such as Lubriderm or Curel as you did with the A&D ointment, do not expose the new tattoo to sun or water (chlorinated, fresh, or salt) for at least two weeks. Even after the healing is complete, exposure to sun without protection of sun block can lessen the colors and the life of the tattoo. In the event of infection/adverse-reaction, I agree to notify this studio and the artist. I should also notify my health care provider and/or the Texas Department of State Health Services, Drugs and Medical Devices Group (1-888-839-6676). * Any touch-up needed to my tattoo, due to my own negligence, will be done at my own expense. I understand that colors may not appear as bright on darker skin as they do on lighter skin. Initial below:*
[G]. To induce (artist named below) to tattoo my body, on (date below) and in consideration of their doing so, I HEREBY RELEASE, AND HOLD HARMLESS, THE TATTOO ARTIST, TRUE BLUE TATTOO, LLC, AND ANY EMPLOYEES AND ASSOCIATES THEREOF, FROM ALL MANNER OF LIABILITIES, CLAIMS AND DEMANDS, IN LAW AND EQUITY, WHICH I OR MY HEIRS HAVE OR MIGHT HAVE NOW OR HEREAFTER BY REASON OF COMPLYING WITH MY REQUEST TO BE TATTOOED. Initial below:*
Please Answer the following questions...
Are you currently under the care of a physician for any reason?*

YESNO
If Yes, please explain...
Are you currently taking any medication?*

YESNO
If Yes, please explain...
Do you have a history of allergies to anything? *

YESNO
If Yes, please explain...
Have you had any alcohol or medication in the last 24 hours?*

YESNO
If Yes, please explain...
Do you have a history of Low Blood Sugar?*

YESNO
If Yes, please explain...
Do you have a history of Bleeding Disorder?*

YESNO
If Yes, please explain...
Have you had anything to eat in the last 8 hours?*

YESNO
Choose your Tattoo Artist*
Tattoo Price*
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
I.D. #, Passport #, State License #*
Signature*

Clear
Date of Birth*

MonthDayYear
Age*
Take Photo of ID*
Current Date*

MonthDayYear
Date
Please verify that you are human*
Below this line to be filled out by artist.
Customer Name*
Description of tattoo*
Location of tattoo*
Tattoo Price*
Colors used:*
Take Photo of Tattoo
Sterilizer Batch #*
Tattoo Artist Name:*
Verify Customer I.D.*
Verify Date of Birth*

MonthDayYear
Tattoo Artist Signature*
Should be Empty:

TRUE BLUE 1 - INFORMED CONSENT