Flores Tattoo Consent Form
INITIAL IN THE BOXES PROVIDED AFTER READING TO SHOW THAT YOU UNDERSTAND EACH PROVISION. THIS CONTRACT IS BINDING FOR ANY FUTURE PROCEDURES YOU DECIDE TO RECEIVE. FEEL FREE TO ASK ANY QUESTIONS REGARDING THIS WAIVER.
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
I have been fully informed of the inherent risk, known and unknown, can lead to injury including and not limited to: infection, scarring, difficulties in the detection of melanoma; allergic reactions to tattoo pigment, latex gloves, and/or soap. Having been informed of the potential risk associated with getting a tattoo, I wish to proceed with the tattoo procedure, application and freely accept and expressly assume any and all risk that may arise from the tattoo process (beginning to end). (PLEASE INFORM YOUR ARTIST OR PIERCER OF ANY ALLERGIES YOU MAY HAVE FOR YOUR SAFETY)
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Flores Tattoo follows a safe and hygienic procedure for tattoos and piercings. However improper care of either tattoo and piercing may result in infection or complications with new tattoos and piercings. Improper care of new piercings may result in problems/ complications which include but are not limited to: infection, metal sensitivity, allergic reactions, inflammation, embedded jewelry, scarring and/or fainting. In addition, I hear by assume all risk or injuries of any kind whatsoever.
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I am not under the influence of any type of alcohol or drugs, and I am voluntarily submitting to be either tattoo or pierced by Flores tattoo without duress or coercion.
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Flores Tattoo is not responsible for the meaning or spelling of either symbol or text that I have provided to them or from flash or pre drawn designs.
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Variations in color and design may exist between the tattoo art that I have selected and the actual tattoo when it is applied to my body. I also understand that over time, the colors and clarity of my tattoo will/may fade due to unprotected exposure to the sun and naturally occurring dispersion of pigment under the skin due to the ago of tattoo and exposures it may be under.
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I release the right to any photographs taken of me and the tattoo/piercing and give consent in advance to their reproduction in prints and/or electronic form.
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I agree that Flores Tattoo has a NO REFUND policy on all tattoos, piercings, and retail sales, trying to refund any sales from Flores Tattoo will result in you being liable for any fees and charges.
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I agree to reimburse Flores Tattoo for any attorney fees and cost incurred in any legal actions I bring against Flores Tattoo. In which either the artist/associate of Flores Tattoo is the prevailing party. I agree that the courts located in the County of Monroe within the state of Pennsylvania shall have the jurisdiction and venue over me and shall have exclusive jurisdiction for the purpose of litigating any dispute that may arise out of or related to this agreement.
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I acknowledge that I have been given adequate opportunity to read and understand this document and that it was not presented to me at the last minute and grasp that I am signing a legal, and binding contract waiving certain rights to recover damages against Flores Tattoo.
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I waive and release to the fullest extent permitted by law, any person of Flores Tattoo from all liability whatsoever, including but not limited to, any and all claims and 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, whether caused by the negligence or fault of either Flores Tattoos staff.
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Flores Tattoo has given me the full opportunity to ask any questions about the procedure and application of my tattoo/piercing, and all of my questions, if any, have been answered to my total satisfaction.
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I understand and will follow the aftercare instructions to the best of my abilities. I acknowledge that it is possible that either my tattoo/piercing may become infected, especially if aftercare instructions that were given aren’t followed. If any touch up work is needed for either my tattoo/piercing it is due to my own negligence. I agree that touch up work will be done at my own expect unless stated otherwise by my artist.
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I understand it is my responsibility to make sure I have eaten before my appointment. If I have not eaten I understand that I am responsible for any complications that may happen (dizziness, fainting, etc.)
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I do not suffer from diabetes, epilepsy, hemophilia, or any heart condition(s). I acknowledge I do not take any type of blood thinning medications or suffer from any medical or skin conditions that may interfere with the procedure, application, or healing of the tattoo/piercing I am receiving. 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 procedures 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 a tattoo/piercing. If I have any heath condition that may affect my tattoo/piercing I acknowledge that I have told my artist and my artist and myself will agree to sign that he/she has been notified and I have notified my artist, in which my artist will deem whether it is safe or not to proceed.
Date of Appointment
-
Month
-
Day
Year
Date
I HAVE READ,UNDERSTOOD AND AGREE TO THIS RELEASE AND UNDERSTAND I AM BOUND BY IT TO THE FULL EXTENT OF THE LAW.
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