Laserfiche WebLink
Tattoo Consent Form <br /> THIS DOCUMENT IS TWO-PAGES , PLEASE INITIAL IN THE BOXES PROVIDED <br /> AFTER READING TO SHOW THAT YOU UNDERSTAND EACH PROVISION, FEEL FREE <br /> TO ASIC ANY QUESTIONS REGARDING THIS WAIVER. <br /> In consideration of receiving a tattoo from Tiny's Ink including its artists, <br /> associates, apprentices, agents, or any employees (herein after referred to as the "Tattoo Studio" I <br /> agree to the following: <br /> I , (Print Name) have been fully informed of the Inherent <br /> risks associated with getting a tattoo. Therefore, I fully understand that these risks, known and <br /> unknown, can lead to injury including but not limited to: infection, scarring, difficulties in the <br /> detection of melanoma and allergic reactions to tattoo pigment, latex gloves and/or soap. Having <br /> been informed of the potential risks associated with getting a tattoo I wish to proceed with the <br /> tattoo procedure and application and freely accept and expressly assume any and all risks that <br /> 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 I, 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 or other bleeding disorders, heart <br /> condition(s) such as cardiac valve disease, nor do I take blood-thinning medication . I do not <br /> have any other medical or skin condition or history of herpes infection at the procedure site. I <br /> do not have any other risk factors of blood-borne pathogens . I am not the recipient of an organ or <br /> bone marrow transplant or, if I am, I have taken the prescribed preventative regimen of antibiotics <br /> that is required by my doctor in advance of any invasive procedure such as tattooing or piercing. I <br /> am not pregnant or nursing. I do not have a mental impairment that may affect my judgement <br /> in getting the tattoo. <br /> List current medications: <br /> - I do not have an allergy to latex or any medications such as antibiotics. <br /> - Are you required for antibiotics prior to surgical/dental procedures. Y_N <br />