Tattoo Consent Form

Client Information
Full Name *

First Name Last Name
Preferred Name

First Name Last Name Pronouns
Age *
Date of Birth *

Month Day Year
Date
Phone Number *

Area Code Phone Number
Email *
example@example.com
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Artist *
I hereby give consent to Zen Ink, LLC to perform a tattoo and in consideration of doing so, I hereby release and forever discharge and hold harmless Zen Ink, LLC, the Tattooist and all affiliates, Owners, Managers and Independent Contractors from any and all claims, damages or legal actions arising from or connected in any way with my tattoo, or the procedure and conduct used in my performing my tattoo, to the fullest extent allowed by the law. *

Yes No
I fully understand that any Independent contractor of Zen Ink, LLC when performing a tattoo, does not act in the capacity as a medical professional. The suggestions made by any Independent Contractor or agent of Zen Ink, LLC are just suggestions. They are not to be construed as, or substituted for advice from a medical professional. I understand that the tattoo will be performed using appropriate techniques, instruments, and pigments. *

Yes No
I understand that infections can occur due to lack of proper hygiene and/or pigment sensitivities. To ensure proper healing of my tattoo, I agree to follow the written and verbal aftercare instructions that will be provided, until healing is complete. I agree that any touch up work, due to my negligence, will be done at my own expense. I understand that a tattoo may take 4-8 weeks to heal properly. *

Yes No
For tattoos in the areas of: Fingers, Hands, Inner Lip, Side of Foot, Bend of wrist, I understand that getting a tattoo in any of the above areas is not guaranteed to stay. It will likely fade or disappear. Touch ups (in any of the listed areas) are to be done at the expense of the client. Likely at the rate of the shop minimum each time. *

Yes No
I understand that I am making a permanent change to my body, and no claims about the possibility of reversing these changes have been made or implied by Zen Ink, LLC or any of its Independent Contractors or agents. *

Yes No
I agree that these waivers also pertain to and are designed to protect any and all establishments of Zen Ink and their Independent Contractors. *

Yes No
I am at least 18 years old. *

Yes No
Do you have a heart condition? *

Yes No
Do you have Diabetes? *

Yes No
Do you have epilepsy? *

Yes No
Do you suffer from Hemophilia? *

Yes No
Do you have Hepatitis/HIV or any other communicable disease? *

Yes No
Do you have sunburn, discoloration, lumps around the tattoo area? *

Yes No
Are you pregnant/breastfeeding? *

Yes No
Have you eaten in the last 5 hours? It's a good idea to eat before hand to increase your blood sugar levels. (If you have not, there is a higher risk for passing out/getting sick, so please ASK us for a snack before we start). *

Yes No
Do you suffer from any condition that makes this procedure dangerous? *

Yes No
Have you consumed drugs/alcohol in the last 8 hours? if so, what and how many? *

Yes No
Have you recently taken: blood thinners, antibiotics, prednisone, accutane? *

Yes No
Are you prone to fainting? *

Yes No
Client is responsible for checking for spelling and correct dates. I agree to check spelling and dates with my artist before the tattoo. *

Yes No
I agree to speak softly and silence my cell phone in order to help keep a calm, spa like environment. *

Yes No
If being tattooed by an apprentice (Rai or Payne), I acknowledge and I am fully aware that my tattoo artist is an apprentice and still learning. I understand that apprenticeships are a form of on-the-job training where the art of the tattoo can be taught, along with techniques for avoiding blood-borne pathogens, handling needles, and studio etiquette. I understand that apprentices are still getting valuable hands-on experience and learning the craft of tattooing. I am aware that this tattoo apprentice does have valid up to date Blood Bourne Pathogen (BBP) training certificate and is registered as a Body Art Practitioner with the county Health Department. I understand the risks involved and consent to be tattooed by this tattoo apprentice.

Yes No Not Applicable
Are you currently sick? In the last 14 days, have you been sick or been in contact with anyone that is sick. *

Yes No
I understand that getting tattooed does temporarily stress the body and the immune system, which could make me more susceptible to illness and infection. I accept this risk. *

Yes No
I understand the Zen Ink has put additional protective measures in place in order to reduce the risk of contamination, virus, or pathogen but it is impossible to completely eliminate that risk. *

Yes No
I agree to release and forever hold harmless Zen Ink and its agents and representatives for any and all claims, damages, or legal actions in the event I contract COVID-19 or any other illness after choosing to get tattooed. *

Yes No
I understand that if I am getting a coverup tattoo that it is possible that portions of the old tattoo may show through. I understand that coverups may take multiple sessions to complete. I also understand that a coverup tattoo cannot cover existing scarring/scar tissue. Furthermore, I understand that with time and sun exposure the old tattoo may show through more than it did initially. Any touch ups on coverup tattoos, to layer in more ink, are at the customers expense. *

Yes No
Have you experienced any symptoms (fever, cough, shortness of breath, chills, body aches, sore throat), had exposure to someone exhibiting COVID-19 symptoms or confirmed illness within the last 14 days, or have you traveled? *

Yes No
I consent to Authorization for Picture of my Tattoo to be used on Social Media, Website etc *

Yes No
Some of the products we use may contain the ingredients below. Are you allergic to any of the following? *

Adhesives Lavender Oil Tea tree Oil Sunflower Oil Cotton Seed Oil Chamomile Oil Jojoba Oil Coconut Oil Peppermint Cocoa Butter Shea Butter Mango Seed Butter Beeswax Witch Hazel Lidocaine Bentonite (Volcanic Clay) Magnesium NONE
Please list any medications you take
Acknowledgment and Waiver
*

I have read this release form and confirm that all the information I have given is correct. I understand that this is a release form and I agree to be legally bound by it.
*

I understand there are no refunds.
*

I understand that I need to take care of the tattoo by following the instructions given to me by the Tattoo Shop.
*

I confirm that the information I provided in this document is accurate and true.
Signed Date *

Month Day Year
Date
Client Signature *

Clear
Please take a picture of your ID or passport *
Should be Empty:

Client Information

Acknowledgment and Waiver