Cayds Place Consent Form

Name*

First NameLast Name

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Date of Birth*

Date

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Any Inso pictures for the tattoo

Description of tattoo*

Location of tattoo*

Picture of Drivers License or ID *

I acknowledge by signing this Release I have been given the full opportunity to ask any and all questions which I might have about obtaining a tattoo from Cayds Place and all my questions have been answered to my full and total satisfaction. I acknowledge I have been advised of the matters set forth below and I agree as follows: 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.*

Initial above

I WAIVE AND RELEASE to the fullest extent permitted by law any person of Cayds Place from all liability whatsoever, including but not limited to, any and all claims or causes of action that I, my estate, heirs, executors or assigns may have for personal injury or otherwise, including any direct and/or consequential damages, which result or arise from the procedure and application of my tattoo, whether caused by the negligence or fault of either Cayds Place, or otherwise.*

Initial above

Cayds Place 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.*

Initial above

Cayds Place has given me instructions on the care of my tattoo while it's 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.*

Initial above

I am not under the influence of alcohol or drugs, and I am voluntarily submitting to be tattooed by Cayds Place without duress or coercion.*

Initial above

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 an 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. I am not on any medication that has not been brought to the attention of Cayds Place. I am not of any antibiotics. *

Initial above

Cayds Place is not responsible for the meaning or spelling of the symbol or text within the tattoo design. *

Initial above

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 over time, the colors and the clarity of my tattoo will fade due to unprotected exposure to the sun and the naturally occurring dispersion of pigment under the skin.*

Initial above

A tattoo is a permanent change to my appearance and can only be removed by laser or surgical means, which can be 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.*

Initial above

I release the right 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 waive the right to take any pictures of you and your completed tattoo please inform me at the appointment).*

Initial above

I agree that Cayds Place has a NO REFUND policy on any tattoos and/or retail sales and I will not ask for a refund for any reason whatsoever. I agree that if I do not show up to my scheduled appointment I will be charged 100 percent of the cost of the tattoo. I agree if I neglect any part of the provided information on this document and I can not be tattooed, I will be charged 100 percent of the tattoo cost. *

Initial above

I agree to reimburse Cayds Place for any attorneys' fees and costs incurred in any legal action I bring against Cayds Place and in which either the Artist of Cayds Place is the prevailing party. I agree that the courts of located in Stark County within the State of Ohio shall have jurisdiction and venue over me and shall have exclusive jurisdiction for the purposes of litigating any dispute arising out of or related to this agreement.*

Initial above

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 Cayds Place. *

Initial above

If any provision, section, subsection, clause or phrase of this release is found to be unenforceable or invalid, that portion shall be severed from this contract. The remainder of this contract will then be construed as though the unenforceable portion had never been contained in this document.I hereby declare that I am of legal age (and have provided valid proof of age and identification) and am competent to sign this Agreement. I HAVE READ THE AGREEMENT, I UNDERSTAND IT, AND I AGREE TO BE BOUND BY IT.*

AFTERCARE INSTRUCTIONS: Leave protective bandage on for 3-5 days. After the 3-5 days, remove the bandage using clean hands, antibacterial soap and warm water. Pat dry with clean paper towel and apply healing ointment. Repeat the washing and ointment morning and night for two weeks. Avoid soaking the tattoo in water for 3 weeks. Avoid direct sunlight for 3 weeks. After the 3 weeks, you can carry on as regular with lotions, exfoliants and sunscreens. Should there be any abnormal swelling or sign of infection, please consult a physician at the first sign of infection. I HAVE READ AND UNDERSTAND THE AFTERCARE INSTRUCTIONS. I ACCEPT THAT FAILURE TO FOLLOW THE POST-PROCEDURE INSTRUCTIONS MAY RESULT IN A LOSS OR DISCOLORATION OF PIGMENT RESULTING IN A NEED FOR MORE FREQUENT TOUCHUPS. NO GUARANTEES, NO REFUNDS. **

I acknowledge by signing this agreement that I have been given the full opportunity to ask any and all questions which I might have about the obtaining of a tattoo and that all my questions have been answered to my full satisfaction. I specifically 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 previously advised my tattooist. I am not under the influence of alcohol or drugs.

I do not have medical or skin conditions such as but not limited to: acne, scarring (Keloid,) eczema, psoriasis, freckles, moles or a sunburn in the area to be tattooed that might interfere with said tattoo.

I acknowledge it is not reasonably possible for the representatives or 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 if in the event that I do not take proper care of my tattoo after I have received aftercare instructions and I have agreed 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.

I realize that variations in color and design may exist between any tattoos as selected by me and ultimately applied to my body. I understand that if my skin color is dark, the colors will not appear as bright as they do on light skin.
I understand that if I have any skin treatment, laser hair removal, plastic surgery or other skin altering procedure, it may result in adverse changes to may tattoo.

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 a physical, mental or medical impairment or disability which might affect my well-being to decide directly or indirectly to have a tattoo.

I acknowledge I am over the age of eighteen and that I have truthfully represented to my tattoo artist that the obtaining of a tattoo is by my choice alone, I consent to the application of the tattoo and to any actions or conduct of the representatives and employees of the tattoo shop reasonably necessary to perform the tattoo procedure.

Date*

Date

Signature*

Cayds Place Consent Form

Artist Information