Consent Form Proj Ink

INFORMED CONSENT TO RECEIVE BODY ART at PROJ INK

In consideration of receiving permanent body art from Kachi Xiong, tattoo artist at Proj Ink, 6643N Milburn Ave Suite 107 Studio 18 Fresno, Ca 93722

(together with its employees, apprentices, and agents at Proj Ink

(Name of Client)*

First and Last name

confirm the following by initialing each item:

I am the person on the legal ID presented as proof that I am at least 18 years of age.*

Initial

I do not suffer from diabetes, epilepsy, hemophilia, heart condition(s), nor do I take blood thinning medication and do not have any other medical or skin condition that may interfere with the procedure, application or healing of the tattoo. 'if such conditions apply, (I have received medical clearance from my doctor before my tattoo session and provided supporting documents)*

Initial

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 an invasive procedure as tattooing or piercing.*

Initial

What (design etc.)

Where( placement)

All questions about the body art procedure have been answered to my satisfaction, and I have been given aftercare instructions for the procedure I am about to receive.*

I understand that 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.*

Initial

I am not under the influence of alcohol or drugs and I am voluntarily submitting to be tattooed duress or coercion.*

Initial

I understand there is a possibility of an allergic reaction and infection and will not hold Proj Ink accountable for any allergic reactions to the elements/inks used during our session*

Initial

I understand that tattoo inks, dyes, and pigments have not been approved by the federal Food and Administration(FDA) and that the health consequences of using these products are unknown.*

Initial

I agree to follow all instructions concerning the care of my body art, and that any touch ups due to own negligence will be done at my own expense.*

Initial

I agree to immediately notify the artist in the event I feel lightheaded, dizzy and or faint before, or after the procedure.*

Initial

I authorize Proj Ink to photograph and/or video record my tattoo during our session for the of marketing/portfolio showcase and allow publication on Proj Ink website or social media platforms.*

Initial

I acknowledge that the Proj Ink has a NO REFUND policy on tattoos and/or retail sales and will not for one.*

Initial

I agree to reimburse Proj Ink for any attorneys' fees and costs incurred in any legal action I bring Proj Ink and in which either Artist of Proj Ink is the prevailing party. I agree that the courts in the County of Fresno within the State of California shall have jurisdiction and venue over me shall have exclusive jurisdiction for the purposes of litigating any dispute arising out of or related to agreement.*

Initial

I have been fully informed of the risks of body art including but notlimited to infection, scarring, difficulties in detecting melanoma, and allergic reactions to tattoo pigment, jewelry metals, latex gloves, and antibiotics. Having been informed of the potential risks associated with body art, I still wish to proceed with this body art procedure and assume any and all risks that may arise from this body art procedure. 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 Proj Ink.*

Type in First and Last name

Client Signature*

Date '*

Date

Type of ID

File Upload '

Please submit copy of ID for reference (may submit in person)