Tattoo Consent Form

Full Legal Name*

First NameLast Name

Chosen Name

First NameLast Name

Preferred Pronouns (he/she/they): blanks

Age*

Date of Birth*

Date

Phone Number*

Email*

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Are you under the influence of drugs or alcohol?*

YesNo

Pregnancy or Nursing?*

YesNo

Do you have a communicable disease?*

YesNo

Skin conditions (e.g. Rashes, eczema, infection, psoriasis, freckles, etc.)

If yes, please identify the condition.

Medical History (e.g. DIabetes, Cardiovascular Disease, Epilepsy, Blood-related disease etc.)

If yes, please identify the condition.

Description Of Tattoo*

In consideration of receiving a tattoo from * at Orchid Oddities Tattoo and Curio; together with its employees, apprentices and agents, the “Orchid Oddities Studio”, I agree to the following:

That I, First Name* Last Name* (legal name) have been fully informed of the inherent risks, associated with getting a tattoo. I fully understand that these risks, known and unknown, can lead to injury, including but not limited to infection, scarring, difficulties in detecting melanoma and allergic reactions to tattoo pigment, latex gloves, and/or soap. Having been informed of the potential risks associated with getting a tattoo, I still wish to proceed with the tattoo application and I freely accept and expressly assume any and all risks that may arise from tattooing.

*

TO WAIVE AND RELEASE to the fullest extent permitted by law each of the Artist and the Tattoo Studio from all liability whatsoever, for any and all claims or causes of action that I, my estate, heirs, executors or assigns may have for personal injury or otherwise, including any direct and/or consequential damages, which result or arise from the application of my tattoo, whether caused by the negligence or fault of either the Artist or the Tattoo Studio, or otherwise

*

That both the Artist and the Tattoo Studio have given me the full opportunity to ask any and all questions about the application of my tattoo and all of my questions have been answered to my total satisfaction.

*

The Artist and the Tattoo Studio have given me instructions on the care of my tattoo while it’s healing, and I understand them and will follow them. I acknowledge that it is possible that the tattoo can become infected, particularly if I do not follow the instructions given to me. If any touch-up work to the tattoo is needed due to my own negligence, I agree that the work will be done at my own expense.

*

I am not under the influence of alcohol or drugs, and I am voluntarily submitting to be tattooed by the Artist without duress or coercion

*

Neither the Artist nor the Tattoo Studio is responsible for the meaning or spelling of the symbol or text that I have provided to them or chosen from the flash (design) sheets.

*

Variations in color and design may exist between the tattoo art I have selected and the actual tattoo when it is applied to my body. I also understand that over time, the colors and the clarity of my tattoo will fade due to unprotected exposure to the sun and the naturally occurring dispersion of pigment under the skin.

*

A tattoo is a permanent change to my appearance and can only be removed by laser or surgical means, which can be disfiguring and/or costly and which in all likelihood will not result in the restoration of my skin to its exact appearance before being tattooed.

Photography*

I release all rights to any photographs taken of me and the tattoo and give consent in advance to their reproduction in print or electronic form.I do not agree to the above provision, and remind my Artist and the Tattoo Studio NOT to take any pictures of me and my completed tattoo!

*

I agree to reimburse each of the Artist and the Tattoo Studio for any attorneys’ fees and costs incurred in any legal action I bring against either the Artist or the Tattoo Studio and in which either the Artist or the Tattoo Studio is the prevailing party. I agree that the courts of BC in CANADA shall have personal jurisdiction and venue over me and shall have exclusive jurisdiction for the purpose of litigating any dispute arising out of or related to this agreement.

*

I have been informed of the proper use of equipment for the services I am receiving.

*

I have been advised of all risks associated with the use of equipment required for the services I am receiving.

*

I acknowledge that I have been given adequate opportunity to read and understand this document, that it was not presented to me at the last minute, and I understand that I am signing a legal contract waiving certain rights to recover against the Artist and the Tattoo Studio.

*

I hereby declare that I am of legal age and am competent to sign this Agreement

*

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

*

I HAVE READ THIS AGREEMENT, I UNDERSTAND IT, I AGREE TO BE BOUND BY IT

(IF UNDER THE AGE OF 18) Legal Parent or Guardian Name

First NameLast Name

Relationship blanks

Signed Date*

Date

Client Signature*

Clear

Parent/Guardian Signature

Clear

If under the age of 18, please use ID of Parent or Guardian who is consenting for the client.

Gov't Issued Photo ID (FRONT)*

Gov't Issued Photo ID (BACK)*

Tattoo Consent Form

Client Information

Pre-Procedure Questionnaire

Acknowledgment and Waiver