Consent Form 10/17

Name*

First NameLast Name

Date of Birth (xx/xx/xxxx)*

Phone Number*

Please enter a valid phone number.

I have received an email with instructions where I can view tattoo aftercare instructions. (www.mrmarekart.com) If I have more questions about how to take care of a tattoo I understand I can ask to have aftercare instructions explained to me. Otherwise your artist should go over the instructions before you leave. I understand that tattoo aftercare is not proven by a doctor. I understand that I am encouraged to contact my doctor to see what aftercare is best for me.*

I Agree

I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing.I further acknowledge that Mr Marek Tattoo LLC has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19.I further acknowledge that Mr Marek Tattoo LLC can not guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, staff, and other clients at Mr Marek Tattoo LLC. I voluntarily seek services provided by Mr Marek Tattoo LLC and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while attending my appointment. I attest that:* I am not experiencing any symptoms of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell.* I have not traveled internationally within the last 14 days.* I have not traveled to a highly impacted area within the United States of America in the last 14 days.* I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19.* I have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non contagious by state or local public health authorities.* I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19.I hereby release and agree to hold Mr Marek Tattoo LLC harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of the Tattoo Establishment, or that may otherwise arise in any way in connection with any services received from Mr Marek Tattoo LLC. I understand that this release discharges Mr Marek Tattoo LLC from any liability or claim that I, my heirs, or any personal representatives may have against the Tattoo Establishment with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from Mr Marek Tattoo LLC. This liability waiver and release extends to the Tattoo Studio together with all owners, partners, and employees.*

I Agree

I agree that I have checked with my doctor to make sure that I am healthy enough to get a tattoo.*

I Agree

I understand that there is a possible risk of an allergic reaction to the tattoo ink and a possible infection. I understand that getting a tattoo is a risk to my health if not cared for properly. I understand that before I leave Mr Marek Tattoo Studio LLC that I will obtain printed aftercare info and/or will have the tattoo artist explain how to care for a tattoo. I understand that I am able to view tattoo aftercare on the artist's website. www.mrmarektattoo@gmail.com*

I Agree

I am not under any influence of any mind altering drugs.*

I Agree

I understand and agree to being under Audio/Video surveillance during my time at Mr Marek Tattoo Studio LLC for the artists and your safety. Your tattoo session will be recorded with audio and video.*

I Agree

I certify that I am over 18 years of age.*

I Agree

I agree that the said tattoo design is drawn or designed to my satisfaction. I understand that if I am not 100% comfortable with the tattoo design that I am encouraged to have it redesigned or decline the tattoo.*

I Agree

I agree with the artist's interpretation and style of the said tattoo.*

I Agree

I hereby release the artists/apprentices at Mr Marek Tattoo LLC, the establishment (Mr Marek Tattoo LLC) and the owner of all legal responsibility of the said tattoo and the health of the client. I understand that if I am getting a tattoo from a tattoo apprentice, that a tattoo apprentice is someone that has been tattooing for less than two years. A tattoo apprentice is someone that is in the process of learning to be an established tattoo artist. I understand that a tattoo apprentice is licensed by the state of TN. I understand that the tattoo may have flaws. Mr Marek Tattoo Studio LLC all owners, partners, and employees are not responsible for the tattoo design outcome. The establishment cannot guarantee the tattoo will look exactly how the client wants it to. The establishment can only certify that the artists and apprentice of Mr Marek Tattoo Studio LLC are licensed in the the state of FL to legally tattoo.*

I Agree

I certify that I have received an estimate for the service at Mr Marek Tattoo LLC. I understand that all payments to Mr Marek Tattoo LLC and employees are final. All payments are due at the end of every tattoo session and to be paid in full. All payments to Mr Marek Tattoo LLC and employees are non refundable. The remaining tattoo balance is due in cash.*

I Agree

I hereby release Mr Marek Tattoo LLC, all owners, partners, and employees of any legal responsibility for my health while at the studio location including slips, falls, fainting related injuries, infections, allergic reactions and death.*

I Agree

I certify that I know all needles used for my tattoo are single use, pre-packaged - pre-sterilized. I understand I am able to check all materials used for my tattoo before the tattoo has started. I understand that I am able to have information about the tattoo materials explained to me.*

I Agree

I understand that before my tattoo has started that all my questions have been answered and I am comfortable with the tattoo design, artist, and tattoo establishment.*

I Agree

I authorize and grant Mr Marek Tattoo LLC all owners, partners, and employees to take my photos regarding my experiences with them. I grant Mr Marek Tattoo LLC all owners, partners, and employees to use my photos on Facebook, Twitter, Instagram, and other social media platforms. I allow Mr Marek Tattoo LLC all owners, partners, and employees to edit, alter, copy, or distribute the photos for social media advertising and marketing. I agree that the photos belong to Mr Marek Tattoo LLC all owners, partners, and employees. I understand that I will not receive any monetary compensation. The photographs, digital negatives or prints produced by the Photographer are protected by International Copyright Law (all rights reserved) and the Photographer retains the copyright to all photos and images produced. The Client hereby grants to the Photographer and its legal representatives and assigns, the irrevocable and unrestricted right to use and publish photographs of the client and the clients tattoo/body art/body modification, its guests, attendees, and officials for editorial, trade, advertising, stock, commercial and any other purpose and in any manner and medium; to alter the same without restriction; and to copyright the same. The Client hereby releases Mr Marek Tattoo LLC all owners, partners, and employees from all claims and liability relating to said photographs. I hereby waive my right to inspect or approve the photographs taken. I understand that tattoo artists are considered photographers as part of their job requires them to take photos of their Tattoos/Clients.*

I Agree

Artist Name*

@Mrmarektattoo

Tattoo Description

Tattoo Location

Upload photo of state issued ID.*

Todays Date*

Date

Signature*

Tattoo Consent Form

Photography