Unique Inque, LLC CONSENT FORM

I am at least 18 years of age
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I do NOT have a heart condition Initial*

I understand the risk of fainting, vomiting, and infection including bacterial endocarditis for persons with a heart condition Initial*

I am not pregnant Initial*

I do not have epilepsy, seizures, episodes of fainting, or narcolepsy. Initial*

I am not a hemophiliac Initial*

I am not taking medication such as anticoagulants which may thin blood or interfere with blood clotting Initial*

I do not have HIV, AIDS, hepatitis, or any other communicable diseases Initial*

I do not have a history of skin diseases, skin lesions, or skin sensitivities to soap disinfectants Initial*

I do not have a history of allergies or adverse reactions to pigments, dies, latex, or other skin sensitivities
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I am not under the influence of any alcohol, drugs, blood thinners, such as aspirin or ibuprofen within 24 hours prior to receiving body art procedure and I am voluntarily submitting to be tattooed
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To my knowledge, I do not have any physical, mental, or medical impairment or disability, which may affect my well-being as a direct or indirect part of my decision to have any tattoo related work done
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I agreed to follow all instructions concerning the care of my tattoo while it is healing
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I agree that any touchup work needed because of my own negligence will be completed at my own expense
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I understand that tattoos may cause scarring, bleeding, or swelling, and possibly become infected if not cared for properly Initial*

I understand that the healing process may vary from person to person.
Unique Inque is not responsible for the meaning or spelling of the symbol or text that I have provided to them or chosen. Initial*

I agree that Unique Inque has a no refund policy on tattoos, piercing, and or retail sales and I will not ask for a refund for any other reason whatsoever
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Being of sound mind and body, I hear by release any and all persons representing Unique Inque from all responsibility
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I myself except any and all
responsibility for any consequences from my decision to have any tattoo related work done by anyone representing the business known as
Unique Inque
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I waive and release to the fullest extent permitted by law any person of unique Inque from all liability whatsoever, including, but not limited to, any and all claims or causes of action that l, my state, heirs, executors, or assigns may have for personal injury or otherwise, including any direct and or consequential damages, which result or arise from the procedure and application of my tattoo, whether caused by the negligence or fault of either unique Inque, or otherwise
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I agree myself, heirs, assigns, and legal representatives to hold Unique Inque harmless from all damages, causes of actions and claims, judgments, cost of litigation attorney fees, and all other cost that may arise from my decision to obtain tattoo related work at Unique Inque Initial*

I represent and warrant that I have fully read, understand, and consent to this form, and that the information below is true and correct Initial*

I HAVE READ THE AGREEMENT, I UNDERSTAND IT, AND I AGREE TO BE BOUND BY IT.
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Artist name (Ask your artists name if you are not sure) Name*