Consent to Application of Tattoo and Release and Waiver Of Claims

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I acknowledge by signing this agreement that I have been given the full opportunity to ask any questions which I might have about the obtaining of the tattoo from Artist and/or Employee of Ink Villains Tattoos and that all of my questions have been answered to my full and total satisfaction.

I specifically acknowledge that I have been advised of the facts and matters set forth below, and I agree as follows:

1. I am not a hemophiliac (bleeder). I do not have diabetes, epilepsy, hepatitis, HIV, AIDS, or any other communicable disease. I am not under the influence of alcohol and/or drugs.

2. I acknowledge that it is not reasonably possible for the representatives and employees of Ink Villains to determine whether I might have an allergic reaction to the pigments or process used in my tattoo, and I agree to accept the risk that such a reaction is possible.

3. I acknowledge that infection is always possible as a result of obtaining a tattoo, particularly in the event that I do not take proper care of my tattoo, and I agree to follow all instructions concerning the care of my own tattoo while it is healing. I agree that any touch-up work needed, due to my own negligence, will be done at my own expense.

4. I realize that variations in color and design may exist between any tattoo as selected by me and as ultimately applied to my body. I understand that, if my skin color is dark, the colors will not appear as bright as they do on light skin.

5. I acknowledge that a tattoo is a permanent change to my appearance and that no representations have been made to me as to the ability to later change or remove my tattoo. To my knowledge, I do not have any physical, mental, or medical impairment or disability, which might affect my well being as a direct or indirect result of my decision to have any tattoo related work done at this time.

6. I acknowledge that I have truthfully represented to the employee and representatives of Ink Villains that I am over the age of eighteen (18) years old, and that the following information is true and correct.

7. I acknowledge that obtaining a tattoo is my choice alone, and I consent to the application of the tattoo and to any action or conduct of the employees of Ink Villains reasonably necessary to perform the tattoo procedure.

8. I agree to release and forever discharge and hold harmless Ink Villains and its employees from any and all claims, damages, or legal actions arising from or connected in any way with my tattoo, or the procedure and conduct used to apply my tattoo.

Location of Tattoo

YOU MUST BE AT LEAST 18 YEARS OLD !

Name
Address
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Physician Name
Emergency Contact Name
if None type “NONE”
Do you have a history of bleeding disorders:
Have you ever contacted or have now (Hepatitis A,B,C or Syphilis or HIV+)
Are you a Returning Customer?

5 + 6 =


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