Consent Form 10/17

Name*

First NameLast Name

Date of Birth (xx/xx/xxxx)*

Client Age*

Phone Number*

Please enter a valid phone number.

I have received an email with instructions where I can view tattoo aftercare instructions. (www.mrmarekart.com) If I have more questions about how to take care of a tattoo I understand I can ask to have aftercare instructions explained to me. Otherwise your artist will go over the instructions before you leave. I understand that tattoo aftercare is not proven by a doctor. I understand that I am encouraged to contact my doctor to see what aftercare is best for me.*

I Agree

I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing.I further acknowledge that Mr Marek Art LLC has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19.I further acknowledge that Mr Marek Art LLC can not guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, staff, and other clients at Mr Marek Art LLC. I voluntarily seek services provided by Mr Marek Art LLC and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while attending my appointment. I attest that:* I am not experiencing any symptoms of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell.* I have not traveled internationally within the last 14 days.* I have not traveled to a highly impacted area within the United States of America in the last 14 days.* I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19.* I have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non contagious by state or local public health authorities.* I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19.I hereby release and agree to hold Mr Marek Art LLC harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of the Tattoo Establishment, or that may otherwise arise in any way in connection with any services received from Mr Marek Art LLC. I understand that this release discharges Mr Marek Art LLC from any liability or claim that I, my heirs, or any personal representatives may have against the Tattoo Establishment with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from Mr Marek Art LLC. This liability waiver and release extends to the Tattoo Studio together with all owners, partners, and employees.*

I Agree

I agree that I have checked with my doctor to make sure that I am healthy enough to get a tattoo.*

I Agree

I understand that there is a possible risk of an allergic reaction to the tattoo ink and a possible infection. I understand that getting a tattoo is a risk to my health if not cared for properly. I understand that before I leave Mr Marek Art LLC that I will obtain printed aftercare info and/or will have the tattoo artist explain how to care for a tattoo. I understand that I am able to view tattoo aftercare on the artist's website. https://www.mrmarekart.com/aftercare*

I Agree

I am not under any influence of any mind altering drugs.*

I Agree

I understand and agree to being under Audio/Video surveillance during my time at Mr Marek Art LLC for the artists and your safety. Your tattoo session will be recorded with audio and video.*

I Agree

I certify that I am over 18 years of age.*

I Agree

I agree that the said tattoo design is drawn or designed to my satisfaction. I understand that if I am not 100% comfortable with the tattoo design, tattoo artist or establishment that I am encouraged to have it redesigned or decline the tattoo.*

I Agree

I agree with the artist's interpretation and style of the said tattoo.*

I Agree

I hereby release the artists/apprentices at Mr Marek Art LLC, the establishment (Mr Marek Art LLC) and the owner of all legal responsibility of the said tattoo and the health of the client. I understand that if I am getting a tattoo from a tattoo apprentice, that a tattoo apprentice is someone that has been tattooing for less than two years. A tattoo apprentice is someone that is in the process of learning to be an established tattoo artist. I understand that a tattoo apprentice is licensed by the state of FL. I understand that the tattoo may have flaws. Mr Marek Art LLC all owners, partners, and employees are not responsible for the tattoo design outcome. The establishment cannot guarantee the tattoo will look exactly how the client wants it to. The establishment can only certify that the artists and apprentice of Mr Marek Art LLC are licensed in the the state of FL to legally tattoo.*

I Agree

I certify that I have received an estimate for the service at Mr Marek Art LLC. I understand that all payments to Mr Marek Art LLC and employees are final. All payments are due at the end of every tattoo session and to be paid in full. All payments to Mr Marek Art LLC and employees are non refundable. The remaining tattoo balance is due in cash.*

I Agree

I hereby release Mr Marek Art LLC, all owners, partners, and employees of any legal responsibility for my health while at the studio location including slips, falls, fainting related injuries, infections, allergic reactions and death.*

I Agree

I certify that I know all needles used for my tattoo are single use, pre-packaged - pre-sterilized. I understand I am able to check all materials used for my tattoo before the tattoo has started. I understand that I am able to have information about the tattoo materials explained to me.*

I Agree

I understand that before my tattoo has started that all my questions have been answered and I am comfortable with the tattoo design, artist, and tattoo establishment.*

I Agree

I understand that Mr Marek Art LLC is not equipped with a Lobby. I understand that it is highly not recommended for me to not be dropped off for my appointment. I understand that after my tattoo is completed I am required to leave the studio 5 minutes after my tattoo is completed. I understand I am not allowed to wait inside the studio for a ride to show up to pick me up. I understand clients are given 5 minutes to gather their belongings after their appointment is completed until they are required to leave. I understand that if I am being dropped off that it is my responsibility to have a local coffee shop or restaurant/bar picked out for me to use a ride share service to get to. I understand it is my responsibility to ask for a 30 min heads up for when the appointment will be completed so I can make appropriate ride share accommodations. I understand that if my ride is not on time to pick me up that I will have to wait outside the establishment.*

I Agree

I authorize and grant Mr Marek Art LLC to take my photos regarding my experiences with them. I grant Mr Marek Art LLC to use my photos on Facebook, Twitter, Instagram, and other social media platforms. I allow Mr Marek Art LLC to edit, alter, copy, or distribute the photos for social media advertising ,marketing and legal purposes. I agree that the photos belong to Mr Marek Art LLC. I understand that I will not receive any monetary compensation. The photographs, digital negatives or prints produced by the Photographer are protected by International Copyright Law (all rights reserved) and the Photographer retains the copyright to all photos and images produced. The Client hereby grants to the Photographer and its legal representatives and assigns, the irrevocable and unrestricted right to use and publish photographs of the client and the clients tattoo/body art/body modification, its guests, attendees, and officials for editorial, trade, advertising, stock, commercial and any other purpose and in any manner and medium; to alter the same without restriction; and to copyright the same. The Client hereby releases Mr Marek Art LLC from all claims and liability relating to said photographs. I hereby waive my right to inspect or approve the photographs taken. I understand that tattoo artists are considered photographers as part of their job requires them to take photos/videos of their Tattoos/Clients.*

I Agree

Artist Name*

@Mrmarektattoo

Tattoo Description

Tattoo Location on body

Upload photo of state issued ID.*

Todays Date*

Date

Client Signature*

Artist Signature

Tattoo Consent Form

Clients that did not drive themselves or will be dropped off.

Photography