Adored Ink Tattoo Consent Form

Name*

Legal name if different

Email*

example@example.com

Phone Number*

Area CodePhone Number

Date of appt.*

Date

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Procedure and exact location *

I.e. tattoo of bird on left forearm

Name of the artist and quote $*

I.e. including deposit

Where did you hear about us?*

Any other access needs or allergies

i.e. lighting/noise level adjustments, prefer not to talk, experiencing body pain, low energy, trauma triggers etc.

Age as of your appt.

(must be 18 or older)

ID for age verification

I acknowledge I have been advised of the facts and matters set forth below and I agree as follows: If I have diabetes, epilepsy, hepatitis, hemophilia, HIV-AIDS or any other communicable disease, heart condition or take medicine which thins the blood I have advised my tattooer. I am not pregnant or nursing. I am not under the influence of alcohol or drugs. I acknowledge it is not possible for the representatives and employees of this tattoo shop to determine whether I might have an allergic reaction to the pigments or processes used in my tattoo, and I agree to accept the risk that such a reaction is possible. I acknowledge that infection is always possible as a result of the obtaining of a tattoo, particularly in the event that I do not take proper care of my tattoo. I agree to follow aftercare instructions while my tattoo is healing. I realize that variations in color and design may exist between any tattoo as selected by me and as ultimately applied to my body. I understand that if I have any skin treatments, laser hair removal, cosmetic surgery or other skin altering procedures, it may result in changes to my tattoo. I acknowledge that a tattoo is a permanent change to my appearance and do not hold my tattooer liable for or of the ability to later change or remove my tattoo. I acknowledge I am over the age of eighteen and that I have truthfully represented to my tattooer that the obtaining of a tattoo is by my choice alone. I fully understand the tattoo artist does not act as a medical professional. I agree to release and discharge my artist from any and all claims, damages, or legal actions arising from or connected to my tattoo and the procedure used in the application of my tattoo. I consent to the application of the tattoo. My tattoo artist and I recognize that I may revoke this consent at any time before or during the tattoo procedure.

Signature

By filling out this agreement I grant permission for my photos to be taken on today’s date. I understand that photographs taken of me during this session may be used, wholly or in part, on the internet, in any publication, portfolio, or display, or in any other print or electronic medium as this artist chooses, unless otherwise specified below. I confirm I am 18 years of age or older. I will make no monetary or other claim against this artist for use of the photographs. I understand that my name may or may not be included/credited in any form of publication unless requested otherwise.

Use my images on social networks, publications, portfolios, and/or displays.Keep my images private, do not share with anyone.Do not take my photo.

In consideration of receiving tattoos from Adored Ink, including it’s artists, associates, apprentices, agents, or any employees (hereinafter referred to as the “Adored Ink”. I agree to the following:

I, blanks (print name), have been fully informed of the inherent risks associated with getting a tattoo. Therefore, I fully understand that these
risks, known and unknown, can lead to injury including but not limited to: infection,
scarring, difficulties in the detection of 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 wish to proceed with the tattoo procedure and
application and freely accept and expressly assume any and all risks that may arise
from tattooing.

Initial I WAIVE AND RELEASE to the fullest extent permitted by law any person of Adored Ink from all liability whatsoever, including but not limited to, 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 procedure and application of my tattoo, whether caused by the
negligence or fault of either the Adored Ink, or otherwise.

Initial Adored Ink has given me the full opportunity to ask any question about the procedure and application of my tattoo and all of my questions, if any, have been answered to my total satisfaction.

Initial I do NOT have a history of herpes infection, or the history of cardiac valve disease. Please inform our artist if otherwise.

Initial I do NOT have a history of medicine use or is currently using medication, including being prescribed antibiotics prior to dental or surgical procedures. If so, I will inform my artist.

Signature The Tattoo Studio has given me instructions on the care of my tattoo while it's healing. I understand 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

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

Signature The Tattoo Studio is not responsible for the meaning or spelling of the symbol or text that I have provide to them or chosen from the flash (design) sheets.

Signature I do not suffer from diabetes, epilepsy, hemophilia, heart condition(s), nor do I take blood thinning medication. I do not have any other medical or skin condition that may interfere with the procedure, application or healing of the tattoo. I am not the
recipient of an organ or bone marrow transplant or, if I am, I have taken the prescribed
preventative regimen of antibiotics that is required by my doctor in advance of any
invasive procedure such as tattooing or piercing. I am not pregnant or nursing. I do not
have a mental impairment that may affect my judgement in getting the tattoo.

Signature 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.

Signature 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.

Signature I agree that the Tattoo Studio has a NO REFUND policy on tattoos, piercing and/or retail sales and I will not ask for a refund for any reason whatsoever.

Signature I agree if there’s any disagreement regarding the tattoo, I will resolve this issue privately with the studio. Any type of defamation will result in legal action that I will be responsible paying.

Signature I acknowledge the tattoo ink or pigment is not FDA approved and have unknown health consequences.

Signature - I agree to reimburse the Tattoo Studio for any attorneys' fees and costs incurred in any legal action I bring against Adored Ink and in which either the
Artist of Adored Ink is the prevailing party. I agree that the courts of located in the
County of Riverside within the State of California shall have jurisdiction and venue over me and shall have exclusive jurisdiction for the purposes of litigating any dispute arising out of or related to this agreement.

Signature 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 grasp
that I am signing a legal contract waiving certain rights to recover damages against Adored Ink.

Signature

Notes for sterilized needle