Tattoo Consent Form
Please read, complete, and submit!
Name
First Name
Last Name
Age
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Pre-Procedure Questionnaire
Are you pregnant or nursing?
Yes
No
Do you suffer from diabetes, epilepsy, hemophilia, heart conditions, or any other medical or skin condition that may interfere with the procedure, application, or healing of a tattoo?
Yes
No
If yes, please explain below; if not, please put N/A.
Do you have any skin conditions such as rashes, eczema, infections, psoriasis, freckles in the area being tattooed, etc? If yes, please explain below; if not, please put N/A.
Do you have a medical history, such as diabetes, cardiovascular disease, epilepsy, blood related diseases such as HIV/AIDS, etc? If yes, please explain below; if not, please put N/A.
Acknowledgement and Waiver
In consideration of receiving a tattoo from Laughing Fox Tattoo and 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, 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 and all liability whatsoever, including but not limited to any and all personal injury or otherwise, including any direct and/or consequential damages, which result or arise from the procedure and application of my tattoo, wether caused by the negligence or fault of either the tattoo studio or otherwise. I hold harmless the Tattoo Shop against any claims, expenses, damages, and liabilities.
The tattoo studio 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.
The tattoo studio has given me instructions on the care of my tattoo while its 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 will be done at my own expense.
I will not be under the influence of drugs or alcohol, and I am voluntarily submitting to be tattooed by the Tattoo Studio without duress or coercion.
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 a 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.
The tattoo studio is not responsible for the meaning or spelling of the symbol or text that I have provided to them or chosen from the flash (design) sheets.
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 overtime, the colors and clarity of my tattoo will fade due to the unprotected exposure to the sun and the naturally occurring dispersion of pigment under the skin.
I understand that a tattoo is a permanent change to my appearance and can only be removed by laser or surgical means. Which can cause 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.
I release the rights to any photographs taken of me and the tattoo and give consent in advance to their reproduction in print or electronic form. (For assurance, if you do not want to have your photos shared, please inform your tattoo artist).
I agree that the tattoo studio has a NO REFUND policy on tattoos, and/or retail sales and I will not ask for a refund for any reason whatsoever. If there is any dissatisfaction please contact the studio via email, text, phone call, or other means.
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 located where the legal action is brought on, shall have jurisdiction for the purposes of litigating and dispute arising out of or related to this agreement.
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 the tattoo studio.
I hereby declare that I am of legal age (and have provided proof of age and identification) and am competent to sign this agreement.
I HAVE READ, UNDERSTAND, AND AGREE TO THE ABOVE TERMS.
If any provision, section, subsection, clause or phrase of this release is found to be unenforcable or invalid, that portion shall be severed from this contract. The remainder of this contract will then be construed as though the invalid portion had never been contained in this document.
I confirm that the information I provided in this document is accurate and true.
Date (Of signing)
-
Month
-
Day
Year
Date
Client Signature
Submit
Submit
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