Tattoo Consent Form
Client Information
Name
*
First Name
Last Name
Age
*
Birth Date
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Month
-
Day
Year
Date
Phone Number
*
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Pre-Procedure Questionnaire
Are you under the influence of drugs or alcohol?
*
Yes
No
FEMALE ONLY: Are you pregnant or nursing?
Yes
No
Do you have a communicable disease?
*
Yes
No
Do you have any skin conditions?
*
Yes
No
Skin conditions (e.g. Rashes, eczema, infection, psoriasis, freckles, etc.)
If yes, please identify the condition.
Please tell about your medical history (e.g. DIabetes, Cardiovascular Disease, Epilepsy, Blood-related disease etc.)
If yes, please identify the condition.
PLEASE CHECK THE BOXES PROVIDED AFTER READING TO SHOW THAT YOU UNDERSTAND EACH PROVISION. FEEL FREE TO ASK RAT ANY QUESTIONS REGARDING THIS WAIVER.
In consideration of receiving a tattoo from Rat Tattoo and 9 Lives Tattoo including its artists, associates, apprentices, agents, or any employees (hereinafter referred to as the “Tattoo Studio”)
I agree to the following:
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I have been fully informed of the inherent risks associated with getting a tattoo, including but not limited to infection, scarring, challenges in detecting melanoma, and allergic reactions to tattoo pigment, latex gloves, or soap. Understanding these known and unknown risks, I choose to proceed with the tattoo procedure and freely accept and assume all potential risks that may arise from tattooing.
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I WAIVE AND RELEASE to the fullest extent permitted by law any person of the Tattoo Studio 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 procedures and application of my tattoo, whether caused by the negligence or fault of either the Tattoo Studio, or otherwise.
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The Tattoo Studio has given me 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.
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The Tattoo Studio has given me instructions on the care of my tattoo while it's healing. I understand and 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, l agree that the work will be done at my own expense.
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The Tattoo Studio is not responsible for the meaning or spelling of the symbol or text that I have provided to them or chosen from the flash (design) sheets.
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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. l 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.
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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 any 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 check this provision, please inform the Tattoo Studio NOT to take any pictures of you and your completed tattoo).
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I agree that the Tattoo Studio has a NO REFUND policy on tattoos and/or retail sales and I will not ask for a refund for any reason whatsoever.
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I agree to reimburse the Tattoo Studio of any attorneys' fees and costs incurred in any legal action I bring against the Tattoo Studio and in which either the Artist or the Tattoo Studio is the prevailing party. I agree that the courts of located in the County of Mecklenburg within the state of North Carolina shall have 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.
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l 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 the Tattoo Studio.
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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.
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I hereby declare that l 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, AND I AGREE TO BE BOUND BY IT.
Client Signature
*
Signed Date
*
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Month
-
Day
Year
Date
Submit
Submit
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