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SR0085220
Environmental Health - Public
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4100 – Safe Body Art
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SR0085220
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Entry Properties
Last modified
8/11/2023 3:51:51 PM
Creation date
8/11/2023 3:48:09 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
COMPLIANCE INFO
RECORD_ID
SR0085220
PE
4103
FACILITY_NAME
CACTUS FLOWER TATTOO STUDIO
STREET_NUMBER
1012
Direction
W
STREET_NAME
LODI
STREET_TYPE
AVE
City
LODI
Zip
95240
APN
03311033
ENTERED_DATE
5/2/2022 12:00:00 AM
SITE_LOCATION
1012 W LODI AVE
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\cfield
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EHD - Public
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TATTOO CONSENT FORM <br />THIS DOCUMENT IS TWO -PAGES. PLEASE INITIAL IN THE BOXES PROVIDED AFTER <br />READING TO SHOW THAT YOU UNDERSTAND EACH PROVISION. FEEL FREE TO ASK ANY <br />QUESTIONS REGARDING THIS WAIVER. <br />In consideration of receiving a tattoo from Cactus Flower Tattoo Studio including its artists, <br />associates, apprentices, agents, or any employees (hereinafter referred to as the "Tattoo <br />Studio" I agree to the following: <br />(Print Name) have been fully informed of <br />the inherent risks associated with getting a tattoo. Therefore, I fully understand that these risks, <br />known and unknown, can lead to injury including but not limited to: infection, scarring, <br />difficulties in the detection of melanoma and allergic reactions to tattoo pigment, latex gloves <br />and/or soap. Having been informed of the potential risks associated with getting a tattoo I wish <br />to proceed with the tattoo procedure and application and freely accept and expressly assume <br />any and all risks that may arise from tattooing. <br />- I WAIVE AND RELEASE to the fullest extent permitted by law any person of the Tattoo <br />Studio from all liability whatsoever, including but not limited to, any and all claims or causes of <br />action that I, my estate, heirs, executors or assigns may have for personal injury or otherwise, <br />including any direct and/or consequential damages, which result or arise from the procedure <br />and application of my tattoo, whether caused by the negligence or fault of either the Tattoo <br />Studio, or otherwise. <br />- The Tattoo Studio has given me the full opportunity to ask any question about the <br />procedure and application of my tattoo and all of my questions, if any, have been answered to <br />my total satisfaction. <br />- The Tattoo Studio has given me instructions on the care of my tattoo while it's healing. <br />I understand and will follow them. I acknowledge that it is possible that the tattoo can become <br />infected, particularly if I do not follow the instructions given to me. If any touch-up work to the <br />tattoo is needed due to my own negligence, I agree that the work will be done at my own <br />expense. <br />- I am not under the influence of alcohol or drugs, and I am voluntarily submitting to be <br />tattooed by the Tattoo Studio without duress or coercion. <br />
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