Body & Soul Tattoo Form of Consent
Client consent to service and release of liability
Photo of your Government-Issued Photo Identification (Photo I.D. - NOT A SELFIE -)
*
I acknowledge that a tattoo is a permanent change to my body and can only be removed by a professional, and even successful removal may leave a visible scar. While piercing is not considered permanent, I understand it may leave a visible scar and that scarring may be increased by improper care or infection.
*
Check box to indicate that you understand and agree to the above statement.
I understand that any allergic reaction to ink, jewelry, or processes used in my body art procedure are in no way the fault of Body and Soul Tattoo, and I agree to hold Body and Soul Tattoo, LLC free from liability. I agree to release, defend, indemnify, not sue, and hold harmless Body and Soul Tattoo, LLC.
*
Check box to indicate that you understand and agree to the above statement.
I acknowledge that I am responsible to pay for any touch-ups or re-piercing that is necessary due to my own negligence or improper aftercare.
*
Check box to indicate that you understand and agree to the above statement.
I am fully aware that infection is always a possible result of any body modification procedure and especially if I fail to take proper care of my body art.
*
Check box to indicate that you understand and agree to the above statement.
I have truthfully represented that I am at least 18 years of age. (UCHD code 13.2 states that persons under 18 years of age may receive body piercing provided they have a valid picture ID and for both minor and guardian. Nipple, tongue, genital piercings are prohibited on minors regardless of consent.)
*
Check box to indicate that you understand and agree to the above statement.
I certify that I am not pregnant nor is there a possibility I might be pregnant.
*
Check box to indicate that you understand and agree to the above statement.
I acknowledge that body art procedures are to be paid for in full at time of service and that no refunds will be given once procedure has been done.
*
Check box to indicate that you understand and agree to the above statement.
I certify that I am free from hepatitis, HIV/AIDS, staph infections, and other communicable diseases. (If in doubt we insist on testing for your safety as well as other. If in doubt please notify the artist working on you.)
*
Check box to indicate that you understand and agree to the above statement.
I have brought to my artist attention any mental or physical disorders that I may have including but not limited to: heart conditions, epilepsy, hemophilia, or infections.
*
Check box to indicate that you understand and agree to the above statement.
I certify that to my knowledge I have no physical, mental or medical impairment which may affect my decision to have a body art procedure done.
*
Check box to indicate that you understand and agree to the above statement.
I certify that I am not under influence of illegal substances or alcohol.
*
Check box to indicate that you understand and agree to the above statement.
I acknowledge the decision to get a tattoo or piercing is my own.
*
Check box to indicate that you understand and agree to the above statement.
I acknowledge that a picture may be obtained and that it may be used in portfolios, magazines or books to promote Body and Soul Tattoo, LLC. or its artists. I relinquish all title, claim, compensation or interest to these materials.
*
Check box to indicate that you understand and agree to the above statement.
I understand that a tattoo may only be removed by a surgical procedure at my own expense.
*
Check box to indicate that you understand and agree to the above statement.
I have received and have read all aftercare instructions and have been answered all questions and or concerns that I may have. I acknowledge that it is my responsibility to inform Body and Soul Tattoo, LLC. And the artists of any concerns I have. I acknowledge it is my responsibility to follow all aftercare instructions properly.
*
Check box to indicate that you understand and agree to the above statement.
Body Art Technician
Name of Body Art Technician
Design or Piercing and Placement
Description of Tattoo Design or Piercing & Placement
Client's Full Name
*
First Name
Last Name
Date of Birth
*
/
Month
/
Day
Year
e.g. 03/28/1997
Email
your-email-address@example.com
Parent or Legal Guardian Name
First Name
Last Name
Today’s Date
-
Month
-
Day
Year
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
We aim to create a safe, comfortable atmosphere for kids, parents, & others present in our studio. If your child becomes disruptive or makes others feel uneasy or unsafe, we’ll kindly invite you to leave. If your child decides against getting their ears pierced or does not give their clear consent, we will discontinue the procedure. If the procedure is discontinued, I agree to pay the non-refundable $50 setup fee to cover our preparation time and the cost of supplies.
Check box to indicate that you understand and agree to the above statement.
I certify that all above statements are to the best of my knowledge true and correct.
*
Date Signed
*
/
Month
/
Day
Year
Today's Date
Submit
Should be Empty: