Tattoo Consent Form

Photo Identification *

Upload License or Identification

Please insert screenshot(s) of your desired flash piece(s) *

Flash Sheet Page Number and Placement *

Size*

StandardExtra half inch (additional $5)Extra inch (additional $10)Extra inch and half (additional $15)

Full Name*

First NameLast Name

Date of Birth*

Date

Phone Number*

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Do you have any allergies?*

YesNo

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Consent to tattoo from: (select below)*

Dao Nguyen & Mary Manigque

We may refer to artists, or apprentices in this form as “Dao Nguyen” or "Mary Manigque" & "Inkmiconfidant" I agree to the following:

I have been fully informed of the inherent risks associated with getting a tattoo. Therefore, I fully understand that these risks, & unknown, can lead to injury including but not limited to: infection, scarring, difficulties in the detection of melanoma & allergic reactions to tattoo pigment, latex gloves and/or soap. Having been informed of the potential risks associated with getting a tattoo I wish to proceed with the tattoo procedure & application & freely accept & expressly assume any and all risks that may arise from tattooing.

I am NOT pregnant or breast feeding.

I WAIVE AND RELEASE to the fullest extent permitted by law any person(s) of the "Inkmiconfidant" from all liability whatsoever, including but not limited to, any and all claims or causes of action that I, my estate, 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 the Inkmiconfidant nor the individual artist (Dao Nguyen and/or Mary Manigque).

I have have been given the full opportunity to ask any question about the procedure and application of my tattoo and all of my questions, if any, have been answered to my total satisfaction.

I have been given instructions on the care of my tattoo while it's healing. I understand & will follow them. I acknowledge that it is possible that the tattoo can become infected, particularly if I do not follow the instructions given to me. If any touch-up work to the tattoo is needed due to my own negligence, I agree that the work will be done at my own expense.

I am not under the influence of alcohol or drugs, and I am voluntarily submitting to be tattooed by Dao Nguyen and/or Mary Manigquw (Inkmiconfidant) without duress or coercion.

I do not suffer from diabetes, epilepsy, hemophilia, heart condition(s), nor do I take blood thinning medication. I do not have any other medical or skin condition that may interfere with the procedure, application or healing of the tattoo. I am not the recipient of an organ or bone marrow transplant or, if I am, I have taken the prescribed preventative regimen of antibiotics that is required by my doctor in advance of any invasive procedure such as tattooing or piercing. I am not pregnant or nursing. I do not have a mental impairment that may affect my judgement in getting the tattoo.

Inkmiconfidant (Dao Nguyen and/or Mary Manigque) is not responsible for the meaning or correcting spelling of any text or symbol that I have provide to them or chosen from the design sheets.

Variations in color and design may exist between the tattoo art I have selected and the actual tattoo when it is applied to my body. I also understand that over time, the colors and the clarity of my tattoo will fade due to unprotected exposure to the sun and the naturally occurring dispersion of pigment under the skin.

A tattoo is a permanent change to my appearance and can only be removed by laser or surgical means, which can be disfiguring and/or costly and which in all likelihood will not result in the restoration of my skin to its exact appearance before being tattooed.

I release the right to any photographs taken of me and the tattoo and give consent in advance to their reproduction in print or electronic form. (For assurance, if you do not initial this provision, please inform your artist NOT to take any pictures of you and your completed tattoo

I agree that the Inkmiconfidant has a NO REFUND policy on tattoos, any other services/or retail sales and I will not ask for a refund for any reason whatsoever.

I agree to reimburse Inkmiconfidant for any attorneys' fees and costs incurred in any legal action I bring against "Confidant Studio" and in which either the Artist of the Tattoo Studio is the prevailing party. I agree that the courts of located in the jurisdiction and venue over me and shall have exclusive jurisdiction for the purposes of litigating any dispute arising out of or related to this agreement.

I acknowledge that I have been given adequate opportunity to read and understand this document that it was not presented to me at the last minute and grasp that I am signing a legal contract waiving certain rights to recover damages against "Inkmiconfidant" (Dao Nguyen and/or Mary Manigque_

If any provision, section, subsection, clause or phrase of this release is found to be unenforceable or invalid, that portion shall be severed from this contract. The remainder of this contract will then be construed as though the unenforceable portion had never been contained in this document.

I hereby declare that I am of legal age (and have provided valid proof of age and identification) and am competent to sign this Agreement.

I HAVE READ THE AGREEMENT, & I UNDERSTAND IT, & AGREE TO BE BOUND BY IT.

by signing below, you agree to all above terms & conditions.*