Atelier Bloom Tattoo Co.
Tattoo & Body Piercing Procedure Waiver
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Instagram @ (If you wish to be tagged)
The date of my appointment is
*
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Month
-
Day
Year
Date
I, the undersigned, hereby give my voluntary consent to have a tattoo applied. I understand that tattoos are a form of body modification and that they are permanent. I am over the age of 18 (or the legal age in my jurisdiction) and am in good physical and mental health. I acknowledge that I have been provided with sufficient information regarding the tattooing process, including but not limited to, the nature of the procedure, any potential risks, and aftercare instructions.
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I agree to this statement
I consent to the tattoo studio and artist taking photographs of my tattoo during and after the procedure, which may be used for promotional or portfolio purposes, both online and offline, unless otherwise indicated. I understand that I will not receive any compensation for the use of these images.
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I agree to this statement
I understand and accept that my tattoo will be created as described, and I am satisfied with the design, placement, and size. I acknowledge that once the tattoo is applied, there will be no opportunity to alter or request changes to the design or placement without incurring additional charges.
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I agree to this statement
I understand that tattoos are permanent and non-refundable. If I experience any issues with the tattoo, including fading or other complications, I will notify the studio within a reasonable period of time, and they may offer touch-ups or revisions in accordance with their policies. I agree that touch-ups, if necessary, will be provided at the discretion of the studio and may incur additional charges.
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I agree to this statement
I understand that this is a binding contract with Tattoo Studio & I have been given full opportunity to ask any and all questions about my procedure. All of my questions have been answered to my satisfaction. I understand that my procedure may be permanent, and may require surgical procedure for removal. I am aware that removal may cause scarring.
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I agree to this statement
I do not have any medical conditions or communicable diseases (including but not limited to diabetes, epilepsy, hemophilia, hepatitis, HIV, AIDS, tuberculosis, COVID19). I do not have a skin condition that may interfere with the proper healing of my procedure (including but not limited to acne, scarring or keloids, eczema, psoriasis, freckles, moles, or sunburn). I am not pregnant or nursing. I have informed the agent of Tattoo Studio and documented below of any exceptions to the above. I am not under the influence of drugs, alcohol, or any narcotic, including but not limited to prescription pharmaceuticals, & over the counter medications. I am aware that being under the influence can have an adverse effect on the procedure. I agree that Tattoo Studio cannot determine if I will have an allergic reaction to any of the products used to complete my procedure. I attest that I have no known allergies, or if I do I have documented them on the back of this form and alerted the agent of Tattoo Studio.
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I agree to this statement
I am aware of the possibility of infection with my procedure. I understand that when I leave the premises of Tattoo Studio, my procedure is only half complete. It is my responsibility to follow the aftercare procedures recommended by Tattoo Studio. Tattoo Studio makes no claim to the success or validity of the recommended aftercare procedures, they are simply guidelines. I understand that while tattoo artists adhere to strict hygiene standards and use sterilized equipment, there is still an inherent risk of complications. I accept full responsibility for my decision to receive a tattoo and acknowledge that any complications resulting from the procedure are my sole responsibility. I agree to not hold Tattoo Studio liable for any necessary touch-up work cause by my own negligence. I understand that skin color will have an effect on the final result of my tattoo. I agree to leave the premises of Tattoo Studio or any other location where Tattoo Studio is engaged in business promptly upon request, for any reason whatsoever, by any employee or agent of Tattoo Studio.
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I agree to this statement
Today's Date
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Month
-
Day
Year
Date
Signature
*
Please upload clear photos of both the FRONT and BACK of your drivers license.
*
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