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COMPLIANCE INFO
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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YOSEMITE
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4100 – Safe Body Art
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PR0547362
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COMPLIANCE INFO
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Entry Properties
Last modified
3/8/2024 9:39:03 AM
Creation date
6/27/2023 9:22:58 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
COMPLIANCE INFO
RECORD_ID
PR0547362
PE
4120
FACILITY_ID
FA0026918
FACILITY_NAME
TINY'S INK (BARBOSA, SALOMON)
STREET_NUMBER
228
Direction
W
STREET_NAME
YOSEMITE
STREET_TYPE
AVE
City
MANTECA
Zip
95336
CURRENT_STATUS
02
SITE_LOCATION
228 W YOSEMITE AVE
P_LOCATION
04
QC Status
Approved
Scanner
SJGOV\cfield
Tags
EHD - Public
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Tattoo Consent Form <br /> THIS DOCUMENT IS TWO-PAGES, PLEASE INITIAL IN THE BOXES <br /> PROVIDED AFTER READING TO SHOW THAT YOU UNDERSTAND EACH <br /> PROVISION . FEEL FREE TO ASK ANY QUESTIONS REGARDING THIS <br /> WAIVER. <br /> In consideration of receiving a tattoo from Tiny's Ink including its <br /> artists, associates, apprentices, agents, or any employees (herein after referred to as the <br /> "Tattoo Studio" I agree to the following: <br /> I , (Print Name) have been fully informed of the <br /> Inherent risks associated with getting a tattoo. Therefore, I fully understand that these <br /> risks, known and unknown, can lead to injury including but not limited to : infection, <br /> scarring, difficulties in the detection of melanoma and allergic reactions to tattoo <br /> pigment, latex gloves and/or soap. Having been informed of the potential risks associated <br /> with getting a tattoo I wish to proceed with the tattoo procedure and application and <br /> freely accept and expressly assume any and all risks that may arise from tattooing. <br /> - I WAIVE AND RELEASE to the fullest extent permitted by law any person of <br /> the Tattoo Studio from all liability whatsoever, including but not limited to, any and all <br /> claims or causes of action that 1, my estate, heirs, executors or assigns may have for <br /> personal injury or otherwise, including any direct and/or consequential damages, which <br /> result or arise from the procedure and application of my tattoo, whether caused by the <br /> negligence or fault of either the Tattoo Studio, or otherwise. <br /> - The Tattoo Studio has given me the full opportunity to ask any question about <br /> the procedure and application of my tattoo and all of my questions, if any, have been <br /> answered to my total satisfaction. <br /> - The Tattoo Studio has given me instructions on the care of my tattoo while it's <br /> healing. I understand and will follow them. I acknowledge that it is possible that the <br /> tattoo can become infected, particularly if I do not follow the instructions given to me. If <br /> any touch-up work to the tattoo is needed due to my own negligence, I agree that the <br /> work will be done at my own expense. <br /> - I am NOT under the influence of alcohol or drugs, and I am voluntarily <br /> submitting to be tattooed by the Tattoo Studio without duress or coercion. <br /> - I do not suffer from diabetes, epilepsy, hemophilia, heart condition(s), nor do I <br /> take blood-thinning medication. I do not have any other medical or skin condition that <br /> may interfere with the procedure, application or healing of the tattoo. I am not the <br /> recipient of an organ or bone marrow transplant or, if I am, I have taken the prescribed <br /> preventative regimen of antibiotics that is required by my doctor in advance of any <br /> invasive procedure such as tattooing or piercing. I am not pregnant or nursing. I do not <br /> have a mental impairment that may affect my judgement in getting the tattoo . <br /> - The Tattoo Studio is NOT responsible for the meaning or spelling of the <br />
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