TATTOO
_AFTERCARE
_WORKS
CONSENT FORM
_JOURNAL
_MIGHTYKILLERS®
TATTOO
_AFTERCARE
_WORKS
CONSENT FORM
_JOURNAL
_MIGHTYKILLERS®
Consent and Release Agreement
Name
*
First Name
Last Name
Date of Birth
*
MM
DD
YYYY
Email
*
Phone
(###)
###
####
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Emergency Contact
Emergency Contact Name
First Name
Last Name
Emergency Contact Phone
(###)
###
####
Client Evaluation
Have you eaten in the last 4 hours?
Yes
No
Are you under the influence of alcohol or drugs?
Yes
No
Have you ingested any anticoagulants (blood thinners) in the last 24 hours?
Yes
No
Have you ingested any medication that can inhibit the ability to heal a skin wound?
Yes
No
Do you have hemophilia, epilepsy, history of seizure, fainting, narcolepsy, or other conditions that could interfere with the tattoo process?
Yes
No
Do you have a history of skin diseases that might inhibit the healing of the tattoo process?
Yes
No
Do you have any communicable diseases (i.e. Hepatitis A, Hepatitis B, HIV, or any other diseases that can be transmitted to another person during the procedure?
Yes
No
Do you have diabetes, high blood pressure, heart condition, heart disease, or any other conditions that could interfere with the procedure?
Yes
No
I have been fully informed of the inherent risks associated with getting a tattoo. Therefore, I fully understand that these risks, known and unknown, can lead to injury including but not limited to: infection, scarring, difficulties in the detection of melanoma and allergic reactions to tattoo pigment, latex gloves and/or soap. Having been informed of the potential risks associated with getting a tattoo I wish to proceed with the tattoo procedure and application and freely accept and expressly assume any and all risks that may arise from tattooing.
Yes
No
I WAIVE AND RELEASE and discharge the artist, Marvin King, from any and all claims, damages, demands, and legal actions arising from or connected in any way to my tattoo and the procedure used in its application.
Yes
No
I agree to follow the aftercare instructions provided by the artist, Marvin King. I understand that improper aftercare may result in infection or other complications, and I release the artist from any liability associated with my failure to follow aftercare instructions.
Yes
No
I consent to the artist, Marvin King, taking photos of the tattoo and the process for their portfolio, marketing, or social media purposes. I understand that these images will not be used for any other purposes without my consent.
Yes
No
Variations in color and design may exist between the tattoo art I have selected and the actual tattoo when it is applied to my body. I also understand that over time, the colors and the clarity of my tattoo will fade due to unprotected exposure to the sun and the naturally occurring dispersion of pigment under the skin.
Yes
No
A tattoo is a permanent change to my appearance and can only be removed by laser or surgical means, which can be disfiguring and/or costly and which in all likelihood will not result in the restoration of my skin to its exact appearance before being tattooed.
Yes
No
I agree that there a NO REFUND policy on tattoos and I will not ask for a refund for any reason whatsoever.
Yes
No
*
By submitting this form, I acknowledge I have read and understood all the terms and conditions of this consent and release form. I understand the risk involved and accept them. I hereby consent to the application of the tattoo and release the artist from any liability.
Thank you! Your information has been submitted for review.
