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.

Illness Symptoms: I confirm that I am not presenting any cold or flu-like symptoms including: dry cough, runny nose, sore throat, shortness of breath, loss of sense of taste or smell, fever - temperature: 100 degrees or above*

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

Duress/Influence: 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.*

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?*

Spelling: Neither the Artist nor Moms Custom Tattoo & Body Piercing is responsible for the meaning or spelling of the symbol or text that I have provided to them.*

I acknowledge

Fading: Variations in color/design may exist between the art I have selected and the actual tattoo. I also understand that over time, the colors and the clarity of my tattoo will fade due to natural dispersion of pigment under the skin.*

I acknowledge

Touch Up: I understand that I am responsible for the care and maintenance of my tattoo once I leave the shop.If I have any healing issues or concerns within the first two months, I will contact my artist directly.I understand that my touch up may not be complimentary. 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 understand

Permanent: 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.*

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).*

Age of Consent: I acknowledge I am over the age of eighteen and that I have truthfully represented to my tattoo artist that the obtaining of a tattoo is by my choice alone. I consent to the application of the tattoo and to any actions or conduct of the representatives and employees of the tattoo shop reasonably necessary to perform the tattoo procedure.*

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

Pre-Numbing Products: Use of pre-numbing products without approval from your artist may result in the loss of your deposit and a need to reschedule. Artists have the right to refuse service if pre-numbing is used in the area that will be tattooed.*

I agree

I understand results are not guaranteed when tattoo is performed by a learning apprentice.*

I understand

Changes and direction of designs are for learning; I understand I may not be able to make the design revisions I want for this tattoo.*

I understand

I understand that the tattoo I am getting is for technique and skill learning for the studio apprentice. The rate that I am paying is at a lower cost to compensate for this.*

I understand

I understand that as this is a apprentice tattoo, the artist may have restrictions on the size & placement of the tattoo.*

I understand

I understand that this is a apprentice tattoo and any changes to the design are up to the artist's discretion but will be communicated*

I understand

This apprentice is learning; as part of that process, I agree to keep communication open to follow up questions regarding healing. If a touch up is needed, I will contact my artist directly about what needs touched up. I agree to these follow ups and documentation of the healing tattoo for educational purposes.*

I agree

I understand I may request my service provider to wear a mask for the duration of my appointment.*

I understand

I understand my service provider may request that I wear a mask during my appointment.*

I understand

If I have any issues or concerns with the way the apprentice conducts themselves during this process, I will communicate with Beth Swilling directly and immediately. I understand I can provide feedback to Beth Swilling at any time.*

I agree

Snacks And Water Breaks: I understand that due to COVID-19, snack and water breaks look a little different. If I need a moment to drink some water or eat a little snack, I will first inform my artist so that they can safely stand by 6 feet while I remove my mask. This allows both of us to adhere to the social distancing recommendation of the CDC.*

I understand

Deposits: Deposits will apply to the final appointment for my tattoo. They are nonreturnable and nonrefundable. If it is my final appointment, the deposit will be applied first and whatever payment method you prefer can be used after that (this includes cash, card, or gift card).*

I understand

Questions: I acknowledge that I have been given adequate opportunity to read and understand this document, that any and all of my questions have been answered, 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 Moms Custom Tattoo & Body Piercing.*

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!