Tattoo Consent Form

Tattoo Consent Form
Name*

First NameLast Name
Date of Birth (If a minor, guardian signature is required at the bottom of this form)*

MonthDayYear
Date
Driver's License Number:*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address of client*

Street Address, City, State & Zip Code

Street Address Line 2

CityState / Province

Postal / Zip Code
Brief Description of Tattoo & Location on Body:*
Time of appointment:

Hour Minutes

AM/PM Option
Date of appointment

MonthDayYear
Date
Individual Consent:

I declare that I give my full consent to the tattooing being carried out by Venom Tattoo Parlor LLC. I confirm that potential complications, e.g. infection and swelling, for the tattoo appointment undertaken, and aftercare instructions have been explained to me. A written aftercare advice sheet containing more detailed information has been given to me and I agree that it is my responsibility to read this and follow the instructions on it, until the site has healed.

I acknowledge I have been advised of the facts and matters set forth below and I agree as follows:
- If I have diabetes, epilepsy, hepatitis, hemophilia, HIV-AIDS or any other communicable disease, heart condition or take medicine which thins the blood I have advised my tattooer.
- A client with a heart condition may have an increased risk of contracting bacterial endocarditis and should contact his or her physician before receiving any body art procedure;
- I am not pregnant or nursing.
- I am not under the influence of alcohol or drugs.
- I acknowledge it is not possible for the representatives and employees of this tattoo shop to determine whether I might have an allergic reaction to the pigments or processes used in my tattoo, and I agree to accept the risk that such a reaction is possible.
- I acknowledge that infection is always possible as a result of the obtaining of a tattoo, particularly in the event that I do not take proper care of my tattoo.
- I agree to follow aftercare instructions while my tattoo is healing.
- I realize that variations in color and design may exist between any tattoo as selected by me and as ultimately applied to my body.
- I understand that if I have any skin treatments, laser hair removal, cosmetic surgery or other skin altering procedures, it may result in changes to my tattoo.
- I acknowledge that a tattoo is a permanent change to my appearance and do not hold my tattooer liable for or of the ability to later change or remove my tattoo.
- I acknowledge I am over the age of eighteen and that I have truthfully represented to my tattooer that the obtaining of a tattoo is by my choice alone.
- I fully understand the tattoo artist does not act as a medical professional.
- I agree to release and discharge my artist from any and all claims, damages, or legal actions arising from or connected to my tattoo and the procedure used in the application of my tattoo.
- I consent to the application of the tattoo. My tattoo artist and I recognize that I may revoke this consent at any time before or during the tattoo procedure.
- If you have health or medical concerns, please consult a physician before engaging in a body art procedure.
- I am voluntarily obtaining services of his or her own free will and volition.
- I fully understand that I have the ability to ask questions about the body art procedure, before, during, and after the procedure.
By filling out this agreement I grant permission for my photos to be taken on today’s date.
- I understand that photographs taken of me during this session may be used, wholly or in part, on the internet, in any publication, portfolio, or display, or in any other print or electronic medium as this artist chooses, unless otherwise specified below.
- I confirm I am 18 years of age or older OR that I have a guardian with me to sign this agreement for me. I will make no monetary or other claim against this artist for use of the photographs. I understand that my name may or may not be included/credited in any form of publication unless requested otherwise.
I also understand and consent to my studio session being recorded by onsite security cameras for my safety and the safety of my tattoo artist. These onsite security camera recordings are only shared to law enforcement if ever law enforcement action is needed. I understand that the footage recorded with the onsite security cameras is not stored for an extended period of time and I also understand that the only person who has access to said security cameras is the owner of Venom Tattoo Parlor, Alexx Kennedy.

By signing this form, I agree to the paragraph above.
This is how my artist may use my photo:*

Use my images on social media networks, publications, portfolios, and/or displays.Keep my images private, do not share with anyoneDo not take my photograph
Please check if any of the following apply to you.*

DiabetesHistory of HemophiliaHistory skin diseases, skin sensitivities to soap, disinfectants, etc.History of allergies or adverse reactions to pigments, dyes or otherDo you have any communicable diseases (i.e. hepatitis A, hepatitis B, HIV, or any other disease that may be transferred during the procedure)?Use of blood thinning medications in the last 24 hours? (anticoagulants, antiplatelet drugs, or NSAIDS (e.g. aspirin, ibuprofen)Pregnant or nursingIngested any medication that may inhibit the ability to heal a skin wound?Allergic to latex, iodineHistory of skin lesions or other skin sensitivity that might inhibit the healing of the body art procedure?Do you have high blood pressure, heart condition, heart disease, or any other conditions that may interfere with the body art procedure?Do you have epilepsy? History of seizures, fainting, or narcolepsy? or other conditions that may interfere with the body art procedure?NONE OF THE ABOVE
Have you eaten within the past four hours?*
By singing below, I specifically acknowledge that I have been advised of the facts and matters set below and I agree as follows:

I acknowledge that there is a chance I might feel lightheaded, dizzy during or after being tattooed. I agree to immediately notify my tattoo artist in the event I feel lightheaded, dizzy and/or faint before, during, or after the procedure. I understand and fully accept the risks with this procedure and hold Venom Tattoo Parlor LLC harmless from same.

I have informed my tattoo artist of any and all of my known allergies. I acknowledge that it is not always reasonably possible to advance whether I might have an allergic reaction to any of the pigments, dyes, topical preparations, or processes used in the and I agree to accept the risk that such reaction is possible.

I acknowledge that tattoo inks, dyes, and pigments have not been approved by the federal Food and Drug Administration and consequences of using these products are unknown.

I realize that my body is unique and neither Venom Tattoo Parlor LLC nor its employees or contractors can predict how my skin will react as a result of the procedure.

I acknowledge that the procedure may result in a permanent change to my appearance and that no representations made to me as to the ability to later change or remove the results.

I understand that future skin altering procedures such as laser treatments, plastic surgery, implants, and/or injections may alter my tattoo(s), and that I must inform any future service provider that I have tattoos that may effected by my procedure. I understand and accept that is not the fault of Venom Tattoo Parlor LLC or its employees or contractors. I further understand that such changes or degradation may not be correctable through further tattoo procedures.

The nature and method of the proposed tattoo appointment has been explained to me as having the usual risks inherent in the procedure and the possibility of complications during and following its performance. I understand that there may be a certain amount of discomfort or pain associated with the procedure and that other possible adverse side effects may include: minor and temporary bleeding, bruising, redness, or other discoloration and/or swelling. Fading or loss of pigment may occur. Secondary infection in the area of the procedure is rare if properly cared for, but may occasionally occur.

I consent to the admittance of authorized observers to the procedure(s) for the purpose of education or assistance.

I HAVE READ AND UNDERSTAND ALL RISKS AND THE AFTERCARE INSTRUCTIONS. I ACCEPT THAT FAILURE TO FOLLOW THE POST-PROCEDURE INSTRUCTIONS IS NOT VENOM TATTOO PARLOR LLC'S LIABILITY. NO GUARANTEES, NO REFUNDS.

BY SIGNING YOU ARE AGREEING TO EVERYTHING ABOVE AND ACKNOWLEDGE THAT YOU HAVE RECEIVED AND UNDERSTAND THE VERBAL AND WRITTEN AFTERCARE INSTRUCTIONS THAT WERE PROVIDED TO YOU.
Date:*

MonthDayYear
Date
Client Signature:*

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Guardian Name, if Client is under the age of 18:

First NameLast Name
Guardian Signature if Client is under the age of 18:

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