CONSENT & WAIVER FORM
You desire to receive a tattoo with Ephemeral’s semi-permanent tattoo inks. These inks are applied in the same method as traditional tattoo inks. In other words, an artist will apply the tattoo using needles and Ephemeral’s semi-permanent tattoo inks. Unlike traditional tattoos, tattoos using Ephemeral’s semi-permanent inks are “made-to-fade” in up to 3 years. A made-to-fade Ephemeral tattoo is designed to fade, formulated to fade, expected to last up to 3 years, but can last longer than 3 years depending on a number of factors. However, the manner and time for fading can vary with each person and each tattoo. Fading could take several months or even years, and it is possible that permanent marks from the tattoo or the tattooing process will remain. Also, as with any tattoo ink, it is not guaranteed you will ultimately be happy with the vibrancy or color the ink provides as this can be affected by various factors, including but not limited to the ink used, tattooing technique, and skin tone.
Unlike traditional tattoos, Ephemeral semi-permanent tattoo inks include a proprietary blend of polymers in addition to color additives, to achieve the intended fading effect. Like traditional tattoo inks the long-term effects of Ephemeral’s semi-permanent tattoo inks and its ingredients have not been studied, and are not fully understood. The same is true of the degradation of the semi-permanent tattoo inks once transferred to the skin.
Other potential effects from receiving a tattoo which may be related to or exacerbated
by the tattoo procedure, tattoo ink, or both may include:
● Pain (Discomfort)
● Skin sensitivity
● Pin-point Bleeding
● Skin dryness
● Mild scarring
● Trauma at the site
● Infection
● Hypo/Hyper pigmentation
● Blistering
● Burning sensation
● Scabbing / Crusting
● Itching
● Inflammation
● Erosions
● Edema
● Heat sensation
● Oozing
● Pruritus
● Purpura
● Allergic reactions or anaphylaxis
● Potential interference with MRIs
● Difficulties detecting melanomas
● Reactions to latex gloves
● Reactions to soap
● Reactions to wound dressing or covering used
● Reactions to metals, such as, but not limited to nickel, found in some tattoo
needles
I acknowledge that it is not reasonably possible for Ephemeral, the tattoo shop, the tattoo artist applying the tattoo (“Artist”) or the representatives and employees of Ephemeral and the tattoo shop to determine whether I might have an allergic reaction to the color additives, polymers or components of the tattooing device or tattoo ink, such as the metal needles, used to administer my tattoo, and I agree to accept the risk that such a reaction is possible.
There may also be additional risks that have not been anticipated and are not listed above. If you have any of the pre-existing conditions below, please inform your Artist.
Health History Disclosure
● Fainting / Dizziness
● Scarring / Keloiding
● Skin Conditions
● Blood Thinners
● Latex Allergies
● Hemophilia
● Pregnant / Nursing
● Eczema / Psoriasis
If I have any condition that might affect the healing of this tattoo. I will advise my Artist. I'm not under the influence of alcohol or drugs. I am not pregnant or nursing. Like other tattoo inks, the U.S. Food and Drug Administration has not reviewed or approved Ephemeral semi-permanent tattoo inks. Tattoos if pregnant or nursing are prohibited due to the risks they may present to the mother or child.
Use of tattoo removal and fade acceleration technologies, such as laser tattoo removal, with Ephemeral tattoos have not been evaluated. Using these technologies on Ephemeral tattoos may not work as intended or could have adverse effects, such as slowing the fade process and they are not recommended.
I have been fully informed of the inherent risks of getting a tattoo using Ephemeral’s semi-permanent tattoo inks. Having been informed of the potential risk, I still wish to proceed with the tattoo using Ephemeral’s semi-permanent tattoo ink, and I freely accept and expressly assume any and all risks that may arise from it. I waive and release Ephemeral, the Artist, the tattoo shop, and the representatives and employees of Ephemeral and the tattoo shop to the fullest extent permissible by law from any liability whatsoever for any and all claims or causes of action that I, my estate, heirs, executors or assigns may have, including claims for personal injury and claims for direct or indirect damages, arising from or related to the tattoo and/or Ephemeral semi-permanent inks.
The Artist and tattoo studio may share information you provide, and information
regarding your tattoo experience, with Ephemeral. The Artist and tattoo studio may also share photos of your tattoo with Ephemeral. Through this document you agree to provide Ephemeral with and irrevocable license to use these tattoo photos, or copies thereof, for promotional or other purposes.
EPHEMERAL MAKES NO REPRESENTATIONS OR WARRANTIES, EXPRESS, IMPLIED,
STATUTORY OR OTHERWISE, CONCERNING YOUR SATISFACTION WITH EPHEMERAL SEMI-PERMANENT INKS, AND EXCEPT AS STATED HEREIN EXPRESSLY DISCLAIMS ANY AND ALL WARRANTIES OF ANY KIND, EXPRESS OR IMPLIED, INCLUDING WITHOUT LIMITATION THE WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE.
I acknowledge that I have read this Consent and Waiver, that I have executed it
voluntarily and that it is binding upon me, my estate, heirs, executors and assigns.