Emotionally Tatted Tattoo Consent Form main

Name*

First NameLast Name

Date of Birth*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Driver’s License Number*

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Email*

example@example.com

yesno

yesnoother

yesno

Do you have any allergies?*

Please list any factors that could affect your healing process:*

Please leave your instagram handle if you'd like to be tagged:

• I do NOT have any allergies to Melaleuca, Tea Tree or Lavender.

• If ANY type of infection or rash appear or the tattooed area after the procedure, I will advise my tattoo artist.

• I acknowledge it is NOT reasonably possible for the Representatives/Tattoo Artist to determine whether I might have an allergic reaction to the pigments or products used during the tattoo process 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 or follow the aftercare instructions that will be given to me.

• I agree that any touch up work or modifications will be done at my own expense.

• 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 colors will not appear as bright as they do on lighter skin.

• I understand that if I have any skin treatments, laser hair removal, plastic surgery or an other altering procedures, it may result in adverse changes to my 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 as a direct or indirect result of my decision to have a tattoo.

I authorize Emotionally Tatted to use any media taken during session for Socials and Marketing, may include website/instagram/yelp and/or other social platforms.

I have been fully informed of the inherent risks associated with the process of getting a tattoo and the importance of proper aftercare and healing of a tattoo. I fully understand that these risks, known and unknown, can lead to injury, including but not limited to scarring, infection, difficulties in detecting melanoma, allergic reactions to tattoo pigment, latex gloves, and/or soap. I also state that I have not excluded any important health conditions that I have had or may have. I have been informed of the potential risks associated with getting a tattoo, yet I wish to proceed with the tattoo application and I freely accept and expressly assume any and all risks that may arise from tattooing.

Therefore, I hereby release any and all persons representing Emotionally Tatted / Zabreena Sauceda from all responsibility. I accept any and all responsibility myself for the consequences that might stem from my decision to have any tattoo done by the artist. I agree to not sue Emotionally Tatted / Zabreena Sauceda for damages from my decision to have any tattoo work. I agree for myself, heirs and legal representatives to hold Emotionally Tatted / Zabreena Sauceda harmless of all damages, actions, causes of action, claim judgements, costs of litigation, attorney's fees and all other expenses which might arise from my decision to have any tattoo related work done by Emotionally Tatted / Zabreena Sauceda. I hereby acknowledge that by signing this agreement, I certify that all information provided is true.

By signing, I agree all of the above is acknowledged and filled out to the best of my knowledge and consent to a new tattoo.*

Date*

Date

Photo of Driver's License*