Tattoo Indemnity Form and Model Release

PLEASE READ AND SIGN WHEN YOU ARE CERTAIN YOU UNDERSTAND THE IMPLICATIONS OF SIGNING:

1. A tattoo is a kind of body art where a dye is punctured into the dermis layer of the skin to make artistic designs. This is done either for cultural practices, expressionism, or simply for aesthetic purposes to one's body. I understand that a tattoo is considered permanent and may only be removed with a surgical procedure.
2. A tattoo is a permanent change to the appearance of the skin and it may be difficult to modify or remove the tattoo should I decide so later on. I understand that any effective removal of a tattoo or body piercing may leave scarring.
3. I do not have a medical or skin condition that may interfere or cause undesirable results to my skin in the tattoo area.
4. It is my responsibility to inform the tattoo artist of any condition that I may have such as irritations, scarring, eczema, moles, or any that may interfere with said tattoo.
5. Infection is possible after obtaining a tattoo. I shall ensure that I comply with the recommended standard of care to have better healing of my skin. In this regard, I have received aftercare instructions from the tattoo artist and agree to abide by such instructions.
6. There might be instances of touch-up work needed. Touch-up requests need to be submitted within 4 months of procedure date. Any requests past this window may incur an additional cost for such work.
7. It is not the responsibility of the tattoo artist to do clinical tests on my skin whether my skin is sensitive to materials used for tattooing. In such instances, I accept the risks of such allergic reactions.
8. Colors may vary from presented catalogs or images and such color results may depend on the color of my skin as well. 
9. Any skin treatment over the tattoo area may have adverse effects on my tattoo such as laser treatments, chemical treatments, among others. 
10. I understand that there is a chance that I might feel lightheaded or dizzy during or after being tattooed. I agree to immediately notify the artist in the event I feel lightheaded, dizzy, and/or faint before, during or after the procedure.
    
     

By signing and submitting this form, I acknowledge that I have been given the opportunity to ask questions with regard to the risks of obtaining a tattoo which have been answered to me to my satisfaction. The body art described on this form is correctly placed to my specifications. If applicable, I have also confirmed all spelling and grammar necessary in the procedure, and the technition is not responsible for any meanings, mispellings, or grammatical erors. I understand the restrictions associated with this body art procedure as explained by the technician. 

I acknowledge I am at least eighteen (18) years of age, and I am the person on the legal ID presented as proof that I am at least 18 years of age. I have been given written aftercare instructions for the procedure I am about to receive.

I understand that any medical information obtained will be subject to the federal Health Insurance Portability and Accountability Act of 1996 (HIPPA). I likewise have no physical condition that might affect my well-being as a result in having a tattoo on my skin. I am aware of the signs and symptoms of infection, including but not limited to, redness, swelling, tenderness of the procedure site, red streaks going from the procedure site towards the heart, elevated body temperature, or purulent draining from the procedure site. I understand there is a possibility of getting an infection as a result of receiving body art.I will seek professional medical attention if signs and symptoms of infection occur.

I am not under the influence of alcohol or drugs and that I am voluntarily submitting myself to receive body art without duress or coercion. I agree to follow all instructions concerning the care of my body art procedure and that any touch-ups needed due to my own negligence will be done at my own expense.

I give my full consent to the application for obtaining body art at (DoomboxStudio, DBA Atrium Tattoo) and I acknowledge the information I provided in the medical questionnaire is complete and true to the best of my knowledge.

I do hereby give my technitian or his or her assigns licensees, successors in interest, legal representatives, and heirs the irrevocable right to use my name (or any preferred, fictional, or chosen name)(see above) picture, portrait, or photograph in all forms in all media and in all manners, without any restriction as to changes or alterations(including but not limited to composite or distorted representations or derivative works made in any medium) for advertising, trade, promotion, exhibition or any other lawful purposed and I waive any right to inspect or approve any artwork based on the photograph submitted or finished versions incorporating the photographs including written copy that may be created and appear in connection therewith. I trust that you'll showcase my uniqueness respectfully.

I hereby release and agree to hold harmless the acove technitian (but not limited to) [BambiKhan, Atrium Tattoo, DoomBoxStudio, and Grimoire publishing] his or her assigns licensees, successors in interest, legal representatives, and heirs any liability by by any virtue of distortion, optical illusion, or use in composite form whether intentional or otherwise, that may occur in the translation of the photograph submitted unless it can be shown that they and the publication thereof were maliciously caused, produced, and published sole for the purpose of subjecting me to scandal, scorn, reproach, and indignity.

I agree that the technitian owns the copyright to the images created from the photographs that I submit, and I hereby waive any claims I may have based on any usage of the photographs or works derived there from, including but not limited to claims for either invasion of privacy, or libel.I am of full age and competent to sign this release. I agree that this release shall be binding on me, my assigns, licensees, successors in interest, legal representatives, and heirs. I have read this release and am fully familiar with its contents.