Hive Tattoo Studio Client Consent Form

Hive Tattoo Studio Client Consent Form

If the client is a minor, the following must be included in the file: Proof of parental or legal guardian identification in the form of a photo identification. Acceptable forms of ID
Photo of Government issued I.D.*
Before starting a body art procedure, each person seeking a tattoo, branding or body piercing shall be asked about the following conditions:

History of skin disease, skin lesions, or skin sensitivities to soaps or disinfectants.History of hemophilia or excessive bleeding diabetes or other conditions which may affect blood circulation and/or ability to fight infection.History of allergies or adverse reactions to latex, pigments, dyes, disinfectants, metals or other sensitivities related to body art procedures.History of epilepsy, seizures, fainting or narcolepsy.Treatment with anticoagulants or other medications that thin the blood and/or interfere with blood clotting.Currently pregnancy and/or breast-feeding.Any other information that would aid the body art technician or any other individual involved in providing education on the client's suitability for receiving a body art procedure and the client's body healing process.Any client reporting one or more of the above conditions should be encouraged to consult their physician before undergoing a body art procedure.
Indicate by checking the box that the client has*

Received a copy of the Disclosure Statement and Notice for Filing Complaints.Received a copy of the Aftercare Information Sheet.Completed the Client Health Questionnaire, and received any additional, applicable information.
I specifically acknowledge I have been informed of the facts and matters set forth below and I agree to the following . . .*

I am not under the influence of alcohol or drugs.I do not have acne, freckles, moles, or sunburn in the area to be tattooed that might be agitated by the tattoo process (healing excluded).I have looked over my design, checked the spelling if applicable, and give my full consent to the application of my tattoo.I acknowledge that I am not pregnant.I acknowledge that I am free of communicable disease.I acknowledge that I have truthfully represented to the associates, agents, and representatives of Hive Tattoo Studio that I am over eighteen (18) years of age.I acknowledge it is not reasonably possible for the associates, agents, and representatives of Hive Tattoo Studio to determine whether I might have an allergic reaction to the dyes, pigments, or processes used in my tattoo and I agree to accept such risks are possible.I acknowledge that infection is always possible as a result of obtaining a tattoo, particularly in that event that I do not take proper care of my tattoo, and I have been advised of the signs and symptoms of infection that indicate a need to seek medical care.I acknowledge receipt of written instructions advising me of proper care of my tattoo and recognize the absolute necessity of following those written instructions. All questions about the body art procedure have been answered to my satisfaction.I acknowledge that variations in color and design may exist between any tattoos as selected by me and ultimately applied to my body.I acknowledge that the obtaining of my tattoo is my choice alone and I consent to the application of the tattoo and to any actions or conduct of the associates, agents, or representatives of Hive Tattoo Studio that are reasonably necessary to perform the tattoo procedureI agree to release or forever discharge and forever hold harmless Hive Tattoo Studio and it's associates from any and all claims, damages, or legal actions arising from or connected in any way with my tattoo or the procedures and conduct used to apply my tattoo and any and all tattoos applied by Hive Tattoo Studio's associates.I acknowledge that tattoo inks, dyes, and pigments have not been approved by the federal Food & Drug Administration and the health consequences of using these products are unknown.I acknowledge that there is a chance I might feel lightheaded and/or dizzy during or after being tattooed. I agree to immediately notify the practitioner in the event I feel lightheaded, dizzy, and/or faint before, during, or after the procedure.I give permission for Hive Tattoo Studio to photograph and video my tattoo during and after my tattoo session. I understand that the images and artwork may be used for social media, marketing, and other business uses.
I acknowledge that I have received a copy of the Disclosure Statement and Notice for Filing Complaints, received a copy of the Aftercare Information Sheet, and completed the Client Health Questionnaire and received any additional, applicable information. In addition, this record serves as signed documentation that the body art facility performing your tattoo, piercing, and/or branding is a licensed facility by the State of Michigan. It is recommended that individuals or organizations visit www.michigan.gov/bodyartto determine current the license status of the body art facility before proceeding with any.
Apprentice Artist*

I understand that my tattoo is being performed by an apprentice.I understand that there may be some application issues as a result of the learning process.I do not hold Hive Tattoo Studio or its artists liable for any mistakes in my tattoo as a result of the apprentices work.My tattoo is not being performed by an apprentice.
Client/Parent/Legal Guardian Signature*
Date*

MonthDayYear
Date
Date of Body Art Procedure*

MonthDayYear
Date
Name of body art technician performing the body art procedure*
Signature of body art technician
Client's Name*
What are your preferred pronouns

She/HerHe/HimThey/Them
Address*
Age/Date of Birth*

MonthDayYear
Date
Client Contact Information (used only in the event of a communicable disease outbreak investigation or other issues pertaining to client's health)
Telephone*
Format: (000) 000-0000.
E mail Address*
example@example.com
Please describe the design and location of the tattoo, brand or body piercing*
The following may also be used to indicate the location of the body art:
Please include any known complication the client has with any tattooing, branding or body piercing performed at this body art facility.
Name of pigments used with batch numbers.

Solid BlackScab WFSCB190502Hemorrhage WFHRM1926062Laceration WFLCR212801Open Wound WFOW211304Rising Red IJY089050Crimson Red IE038778Dark Skin A021721Vampire A011321Fever A041621Tangerine IE009648Bright Orange IE008624Acropolis Orange WFAO090909Bright Orange WCJBS12519Butano A0322210Thailand Sunset BWFTS203003Straight Orange WFSORG202300Solid Gold J091720Solid Gold IE065084Bumble Bee IE062932Canary Yellow WFCY211703Golden Gate WFGG20150Michealangelo YellowElectric Raspberry ILC09946Cotton Candy IE056064Cotton Candy WCIBS03056Azaela WFAZLA1820020Strawberry WFSTRW200705Saigon Pink 59-0820200Flying Pig Pink WFFPP201203BombayLiberachi Red WFLR022040Graveside Dark 142True Blue J100820Bermuda Blue IE0646540Sinatra Blue WFSB201606Jay Freestyle BlueDonatello Blue WFDTB200710Phantom Blue A0322210Abyss Blue WFABYS192901Chill Blue A021721Waterfall A021621Mediterranean Sea WFMS190612Deep Amethyst WFTDA192602Red-Violet ILC04049Imperial Violet JLC01888Sinful Berry IBG05412Deepest Space IBG01402Exhaust IMC03530Purple Haze WFPHZ200412Light Purple JE017787Panama PurplePurple Rain WFPR191604Purple Heart WFPH202605Sage ILC226515Green Dragon IJY15909Graffiti Green IE033018Granny Smith Green ILC21948Margarita WFDGM202805Iceland Green WFIG201002Everglades Green WFEG202210Rain Forest WFRF200904Vegas Green WFVG191810Toxic Green A033021Dark Gold A010821Putrid Yellow A021721Immovable Light IJY22075Tropical Teal IE053807Caribean Sea WFCS202207Galapagos Green WFGALG210601Dirty Scarlet IRP10741Dark Brown IE025743Brown IE026570Rust IEP16712Deep Red IE004636Flesh Tone IE027929Ochre IE037633Fair Honey WFPRFH190509Medium Skin A032521Light Skin A032221
Include a driver's license, a passport, or state or government-issued identification that includes the parent's or legal guardian's name, picture and date of birth. A copy of the minor's birth certificate and/or court document verifying the parent's or legal guardian's relationship with the minor.

Note: The minor's parent or legal guardian must execute the written informed consent in the presence of the body art technician performing the body art procedure or another individual working in the body art facility.
Should be Empty: