Apprentice Consent Form

Choose your artist*

Full Name*

First NameLast Name

Name you go by if different than above

Pronouns

Birth of Date*

YearMonthDay

Age*

Email*

example@example.com

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

I confirm

COVID Preventative: Mom’s Custom Tattoo and Body Piercing has put in place preventative measures to reduce the spread of COVID-19; This includes all of our studio choosing to be fully vaccinated; however, infection from COVID-19 can happen anywhere and no business can guarantee or completely prevent someone from becoming infected. Further, being in any business could increase your risk of contracting COVID-19*

I understand

Eaten: Have you eaten in the past 4hrs? It's a good idea to before hand to increase your blood sugar levels.*

Risks: I acknowledge that I have been fully informed of the inherent risks, associated with getting a tattoo done by an apprentice. 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, I still wish to proceed with the tattoo application and I freely accept and expressly assume any and all risks.*

I acknowledge

Release: TO WAIVE AND RELEASE to the fullest extent permitted by law each of the Artist and Moms Custom Tattoo & Body Piercing 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 my tattoo, whether caused by the negligence or fault of either the Artist or the Tattoo Studio, or otherwise.*

I agree

Healing: I acknowledge the Artist and Moms Custom Tattoo & Body Piercing have given me instructions on the care of my tattoo while its 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 acknowledge

I confirm

Health and Medical Conditions: Do you have diabetes, epilepsy, hemophilia, a heart condition, allergies and/or take a blood thinning medication or have any other condition that may interfere with the application or healing of the tattoo?*

If yes, please explain:

Medications: Are you currently taking any medications that would interfere with the procedure or the healing of a tattoo such as: Blood Thinners, Glucocorticoid Steroids, or Chemotherapeutic Drugs?*

If yes, please explain:

Organ or Bone Marrow Transplant: Are you the recipient of an organ or bone marrow transplant that has not taken the prescribed preventive regimen of antibiotics that is required by your doctor in advance of any invasive procedure such as a tattoo?*

Pregnant or Nursing: Are you currently pregnant or nursing?*

I acknowledge

I understand

I acknowledge

Legal Action: I agree to reimburse each of the Artist and Moms Custom Tattoo & Body Piercing 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 that the courts of Spokane, Washington 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 agree

Photography: As a part of the learning process, I have agreed to allow the apprentice and/or Beth to take photos of the process as mentioned in the section "Required Follow Up Appointments" For any other use of the 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. (If you do not tick this provision, please advise your Artist).*

I acknowledge

Skin Altering Procedures: I understand that if I have any skin treatments, laser hair removal, plastic surgery or other skin altering procedures, it may result in adverse changes to my tattoo.*

Artist Rate: In exchange for being a "learning canvas" for an apprentice tattooer, I understand I am receiving this tattoo at a reduced rate. I understand any touch ups, reworks, changes to the design or cover tattoo work may not be offered at the same reduced rate if done by the same apprentice tattooer. I also understand that any touch ups, reworks, changes or covers of this tattoo, if performed by another licensed tattoo artist in the studio will be at that artist's current rate.*

I understand

Accompanied Guest: Right now, because of COVID occupancy restrictions, you must be alone for your service unless you need assistance. If you need assistance, the person assisting must follow the same protocols as the client and must leave if/when the client is settled. The assistance must also provide their name and phone number for contact tracing. Please contact your artist before your appointment to let them know you need assistance.*

I Agree

I agree

I understand

I agree

I understand

I agree

I understand

I acknowledge

Please take a photo of your valid identification card*

Military ID

We can not take a photo of Military ID, please type in your military ID number below.

Signature*

Apprentice Consent Form

Thank you for choosing Moms for your new addition!