Suh Homie LLC Tattoo Consent Form

Suh Homie LLC Tattoo Consent Form

Consent: Application for Tattoo, Release of Liability and Waiver to All Claims
3292 Eagle Ave | PO Box 1446 Valdez, AK 99686
Devan 907-831-6832 | Brooke 907-795-5941
Client Information

Please fill out the information below to the best of your knowledge
Full Name*

First NameLast Name
Age*
Date of Birth*

MonthDayYear
Date
Phone Number*

Area CodePhone Number
Email*
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Tattoo Description*
Please describe your tattoo in detail. Size, placement, color, ect.
Body Location of Tattoo*
Appointment Date and Time*
Date and time you, and your artist have agreed upon.
Who is your artist?

DevanBrooke
Health Questionnaire

Please select all that apply to you
Do you have any allergies such as:*

AntibioticsMetalsSoapsLatexAlcoholCosmeticsAdhesivesPetroleumLanolin OilLidocaineShellfishNoneOther
Diseases:*

HepatitisTuberculosisGonorrheaSyphilisHIV/AIDSHerpesStaphAuto-Immune DisorderAsthmaCOVID-19InfectionsNoneOther
Overall Health*

Heart DiseaseHigh Blood PressureDiabetesCurrently Pregnant or BreastfeedingProne to FaintnessSkin Disease/RashEpilepsyHemophiliaProne to Scarring/KeloidsPsoriasisBlood ThinnersEczemaNoneOther
Emergency Name and Phone Number
(Optional)
Are you currently on any medication? Please list:
(Optional, but encouraged)
Do you have other Tattoos?
If so how many?
Acknowledgment and Waiver

By completing and signing this form, I acknowledge that I have been given the full opportunity to ask any and all questions which I might have about obtaining a tattoo from Suh Homie LLC, and that all of my questions have been answered to my full and total satisfaction. I specifically acknowledge that I have been advised of the facts and matters set forth, and I agree as follows:
I have truthfully represented to Suh Homie LLC that I am over the age of eighteen (18). I am competent to sign this agreement. I further understand that providing false information or producing false documents stating my name and/or age to be other than correct, I am liable for prosecution.*

I agree
I acknowledge that it is not reasonably possible for the representatives and employees of Suh Homie LLC to determine whether I might have an allergic reaction to the dyes, pigments or processes used in my tattoo, and I agree to accept the risk that such a reaction is possible. Having been informed of the potential risks associated with getting a tattoo, I wish to proceed with the tattoo application and I freely accept and expressly assume any and all risks that may arise from tattooing.*

I agree
I have been fully informed of the inherent risks associated with getting a tattoo. I fully understand that these risks, known and unknown, can lead to injury.

I agree
I agree and acknowledge that I have chosen the Artist to tattoo me. I agree that the licensures are posted at Suh Homie LLC where I can clearly see them.

I agree
I acknowledge that I have advised my tattoo artist of any condition that might affect the healing of this tattoo. I do not have medical or skin conditions such as but not limited to: acne, scarring (keloid), aczema, psoriasis, freckles, moles, or sunburn in the area to be tattooed that may interfere with said tattoo. If I have any type of infection or rash anywhere on my body, I will advise my tattooer.*

I agree
I waive and release to the fullest extent permitted by law the Artist and Suh Homie LLC from all liabilities, claims, actions and demands, in law or equity, which I, or my state, heirs, executors or assigns, may have for professional injury or otherwise, including any direct and/or consequential damages which result and/or arise from the application of tattoo, whether caused by negligence of fault of either Artist and/or Suh Homie LLC, or otherwise. The Artist and/or Suh Homie LLC have given me written and oral instructions on the care of my tattoo while it is healing, and I have verbalized understanding and will follow the directions explained to me. Any tattoo can become infected, particularly if I do not follow the instructions provided to me. If any touch up work is needed to the tattoo due to my own negligence, I agree that the work will be done at my own expense.

I agree
I am not pregnant or nursing.*

I agree
I am not under the influence of alcohol or drugs. I am of sound mind, voluntarily submitting to be tattooed by the artist without duress or coercion.*

I agree
I acknowledge that infection is always possible as a result of obtaining a tattoo, particularly in the event that I do not take proper care of my tattoo. I have received aftercare instructions and I agree to follow them while my tattoo is healing. I agree that any touch-up work needed, due to my own negligence, will be done at my own expense. This includes sun and ultraviolet frequency damage.*

I agree
I agree to reimburse each of the Artist and Suh Homie LLC for any attorney's fees and costs incurred in any legal action I bring against either Artist and/or Suh Homie LLC in which either the Artist and/or Suh Homie LLC is the prevailing party. I agree that the Alaska courts shall have jurisdiction and venue over me and shall have exclusive jurisdiction for the purpose of litigating and dispute arising out of or related to this agreement.

I agree
I acknowledge that if I am injured on or within 50 ft, but not limited to, of Suh Homie LLC's premises/property, that Suh Homie LLC and any tattooer are not liable and release of any responsibility.*

I agree
I acknowledge that Suh Homie LLC does not offer refunds.*

I agree
I acknowledge that a tattoo is a permanent change to my appearance and that no representations have been made to me as to the ability to later change or remove my tattoo. To my knowledge, I do not have physical, mental or medical impairment or disability which might affect my well being as a direct or indirect result of my decision to have a tattoo.*

I agree
I acknowledge that if my tattoo is a symbol, or something written in a language other than English, that Suh Homie LLC are not responsible for what it may or may not mean.*

I agree
I acknowledge that if my tattoo includes text, that I am responsible for the correct spelling, grammar and punctuation. I have proofed the text before it is applied as a tattoo.*

I agree
I acknowledge that variations in colour and design may exist between any tattoo as selected by me and as ultimately applied to my body. I understand that if my skin is dark, the colours will not appear as bright as they do on light skin.*

I agree
I acknowledge the decision for obtaining my tattoo is my own free will and choice. I consent to the location of the tattoo and the performance of the tattoo procedure.*

I agree
I acknowledge and agree to following any and all instructions provided to me regarding the maintenance of a sanitary environment while I am being tattooed.*

I agree
I agree that the tattoo design is correctly drawn to my specifications and I agree to allow for artist interpretation of the image.*

I agree
I agree to immediately notify my tattooer if I feel lightheaded, dizzy and/or faint before, during or after the procedure. Failure to do so releases Suh Homie LLC and my tattooer of all responsibility.*

I agree
I acknowledge that the sterilization methods used was explained to my full satisfaction. I had the opportunity to ask questions regarding this procedure. All questions were answered to my satisfaction and understanding. All equipment used during the procedure was opened in front of me. I witnessed the proper disposal of the tattoo sharps and sanitary procedures throughout my tattoo. Both written and verbal aftercare instructions were provided to me as Suh Homie LLC's phone number if I do have any questions.

I agree
I acknowledge that I have been given adequate opportunity to read and understand this document, that it was not presented to me last minute, and I understand that I am signing a legal contract waiving certain rights against the Artist and Suh Homie LLC. I agree that I have not been in contact of Covid-19 and show no signs of being sick.*

I agree
Signed Date*

MonthDayYear
Date
Client Signature*

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Photo ID*

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If you have any questions, feel free to call,text, or email us at suhhomiellc@gmail.com or get ahold of us on Facebook.

Thanks, Suh Homie LLC Crew
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Suh Homie LLC Tattoo Consent Form

Client Information

Health Questionnaire

Acknowledgment and Waiver