TATTOO CONSENT FORM

GOOD PAIN ARTWORKS • 112 NE 4th St., Grand Prairie, TX, 75050 • (214) 518-6235
CLIENT INFORMATION

All information provided below is confidential & for professional use only.
CLIENT NAME

First NameLast Name
AGE
Must be 18 or older with valid proof of identification
DATE OF BIRTH

MonthDayYear
2 digit month, 2 digit day, 4 digit yearMM-DD-YYYY
PHONE NUMBER
Format: (000) 000-0000.
EMAIL
example@example.com
ADDRESS

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
OPT IN TO RECEIVE MARKETING FROM GOOD PAIN ARTWORKS?
ACKNOWLEDGEMENT AND WAIVER
In consideration of receiving a tattoo from Good Pain Artworks including its artists, associates, apprentices, agents, or any employees (hereinafter referred to as the "Tattoo Studio" I agree to the following:
I 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, discomfort or pain, 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.
I WAIVE AND RELEASE to the fullest extent permitted by law any person of the Tattoo Studio 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 Tattoo Studio, or otherwise.
The Tattoo Studio has given me written instructions on the care of my tattoo while it's healing. I have read and understand these aftercare instructions, 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 do not suffer from severe medical conditions, 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.
I agree to reimburse the Tattoo Studio for any attorneys' fees and costs incurred in any legal action I bring against the Tattoo Studio and in which either the Artist of the Tattoo Studio is the prevailing party. I agree that the courts of located in the County of Dallas within the State of Texas 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.
If any provision, section, subsection, clause or phrase of this release is found to be unenforceable or invalid, that portion shall be severed from this contract. The remainder of this contract will then be construed as though the unenforceable portion had never been contained in this document.

I hereby declare that I am of legal age (and have provided valid proof of age and identification) and am competent to sign this Agreement.

I HAVE READ THE AGREEMENT, I UNDERSTAND IT, AND I AGREE TO BE BOUND BY IT.
DATE OF APPOINTMENT

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
SIGNED DATE

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
CLIENT SIGNATURE
ARTIST SECTION

To be completed by the Tattoo Artist/ Shop Manager ONLY
ARTIST NAME
LOCATION OF TATTOO
COLOR(s) USED / CATALOGUE #
Should be Empty:

CLIENT INFORMATION

ACKNOWLEDGEMENT AND WAIVER

ARTIST SECTION