I, {fullName} , acknowledge that I am voluntarily requesting and consenting to receive tattoos from Nia Zavala, an unlicensed [blood borne pathogen certified] tattoo artist working from home. I understand that receiving tattoos involves certain risks, including but not limited to:

-Pain or discomfort during the tattooing process.

-Possibility of infection, allergic reactions, or other adverse skin reactions.

-Potential for dissatisfaction with the appearance of the tattoo, including color, size, and placement.

-Scarring or other permanent changes to the skin.

 I have discussed these risks with the tattoo artist and have had the opportunity to ask any questions I may have regarding the tattooing process.

Disclaimer

By signing this consent form, you acknowledge that the tattoo process involves potential discomfort and physical stress. Our priority is ensuring your safety and well-being throughout the session. If, at any point, the tattoo artist observes that you are not tolerating the process well—either physically or emotionally—they reserve the right to stop the session. This decision will be made in the best interest of your health and safety.

 

Medical History 

To ensure the safety of both the client and the tattoo artist, please provide accurate and honest information regarding your medical history.

I certify that:

1. I am not under the influence of drugs or alcohol at the time of this tattoo appointment or any future appointments with the tattoo artist, Nia Zavala.

2. I do not have any medical conditions, skin conditions, or allergies that may increase the risks associated with receiving a tattoo. These may include, but are not limited to:

• Skin conditions (e.g., eczema, psoriasis, keloids)

• Bloodborne illnesses (e.g., hepatitis, HIV)

• Allergies to tattoo ink, latex, or other materials

• Pregnant or nursing status

• Immune system disorders

If I have any concerns about my health or medical history, I have disclosed them to the tattoo artist prior to receiving the tattoo.

 
I understand that providing accurate medical history is essential for ensuring both my safety and the safety of the tattoo artist. I acknowledge that any adverse reactions, complications, or issues resulting from withholding or misrepresenting information about my medical history, health, or other relevant factors are solely my responsibility and not the fault of the tattoo artist.

By signing below, I confirm that I have answered truthfully and take full responsibility for the accuracy of the information provided.

Refund Policy

A non-refundable fee of $20 is required to secure your tattoo appointment. This fee will be applied toward the total cost of your tattoo service. However, the fee will be forfeited if a cancellation or reschedule does not occur within 48-72 hours prior to the scheduled appointment. Clients who fail to notify within this time frame will lose their deposit and will need to pay a new non-refundable fee to book another appointment. By signing this consent form, you acknowledge and agree to the terms of this refund policy.

 
Waiver of Liability

By signing this consent form, I agree that I, {fullName} , am fully aware of and accept the potential risks associated with receiving a tattoo. I acknowledge that Nia Zavala, the tattoo artist, is not a licensed medical professional and cannot provide medical advice.

 
I understand and agree that Nia Zavala cannot be held liable for any dissatisfaction with the tattoo, including but not limited to design, placement, or execution, as I have approved all aspects of the tattoo prior to its application. I also release Nia Zavala from any liability for adverse reactions, medical complications, or issues resulting from my failure to disclose accurate and complete medical history.

 
By signing this consent form, I waive all rights to pursue any legal action, including suing or filing claims against Nia Zavala, for any reason related to the tattooing process or the tattoo itself. This waiver is binding and applies to all tattoos received from Nia Zavala now and in the future.