REINKARNATE TATTOO TATTOO CONSENT FORM
THIS DOCUMENT IS THREE-PAGES. PLEASE READ AND INITIAL IN EACH BOX PROVIDED TO SHOW THAT YOU UNDERSTAND EACH PROVISION. BY INITIALING YOU CONSENT TO THE TATTOO APPLICATION PROCEDURE. PLEASE FEEL FREE TO ASK ANY QUESTIONS REGARDING THIS WAIVER.
In consideration of receiving a tattoo from Reinkarnate Tattoo, including its artists, associates, apprentices, agents or any designated independent contractor (hereinafter referred to as the “Tattoo Studio” I agree to the following:
I, ________________________________ (Print Name) 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, allergic-reactions to tattoo pigments (ink), soaps, and the risk of exposure to Blood Borne Pathogens such as blood, body fluid, saliva, and Hepatitis B/C & HIV. Having been informed of such potential risks associated with getting a tattoo, I wish to proceed with my tattoo procedure application and freely accept and expressly assume any and all risks that may arise from the tattooing.
-I WAIVE AND RELEASE to the fullest extent permitted by law, any person of the Tattoo Studio from all liability whatsoever, including but not limited to, any and all claims or causes of action that I, my estate, heirs, executors or assigns may have for personal injury or otherwise, including any direct and/or consequential damages, which result or arise from the procedure and application of my tattoo, whether caused by the negligence or fault of either the Tattoo Studio, or otherwise.
-I am aware and understand that the tattoo procedure involves the placement of
pigment into the skin’s dermis, the layer of dermal tissue underlying the epidermis. A tattoo is
a permanent kind of body art. A design is made by puncturing the skin with needles and
injecting ink, or pigments into the deep level of the skin. Upon primary injection, pigment is
dispersed throughout a homogenized damaged layer down through the epidermis and upper
dermis, in both of which the presence of foreign material activates the immune system’s
phagocytes to engulf the pigment particles. As healing proceeds, the damaged epidermis
flakes away (eliminating surface pigment) while deeper in the skin granulation tissue forms,
which is later converted to connective tissue by collagen growth. This mends (healing) the
upper dermis, where pigment remains trapped within fibroblasts, ultimately concentrating in
a layer just below the dermis/epidermis boundary. Its presence there is stable, but over time,
the pigment tends to migrate deeper into the dermis, accounting for the degraded detail of
old tattoos. (***NOTE*** Tattoo inks, dyes, and pigments have not been approved by the federal Food and
Drug Administration (FDA) and that the health consequences of using these products are incomplete or unknown.)
– The Tattoo Studio has given me the full opportunity to ask any questions about the procedure and application of my tattoo and has answered any/all questions to my satisfaction.
– The Tattoo Studio has given me instructions on the care of my tattoo during the healing process. I understand and will follow them. I acknowledge that it is possible that the
REINKARNATE TATTOO TATTOO CONSENT FORM
tattoo can become infected, particularly if I do not follow the instructions given to me. If any touch-up work to the tattoo is needed due to my own negligence, I agree that the work will be done at my own expense.
-I am not under the influence of alcohol or drugs, and I voluntarily submit to being tattooed without duress or coercion.
-I do not suffer from diabetes, epilepsy, hemophilia, a heart condition(s), nor do I take blood thinning medication. I do not have any medical or skin condition that may interfere with the procedure, application, or healing of my tattoo. I am not a recipient of organ or bone marrow transplants, or if I am, I have taken the prescribed preventative regimen of antibiotics that is required by my doctor in advance of any invasive procedure such as tattooing. I am not pregnant or nursing and I do not have a mental impairment that may affect my judgement in getting a tattoo.
-The Tattoo Studio is not responsible for the meaning/spelling of any text or symbol that I have provided to them or have chosen from the internet, flash, photos, or books.
-The Tattoo studio does not touch up hands or feet for FREE hands and feet exfoliate at a much faster rate than anywhere else on the body.
-Variations in color/design may exist between the tattoo art I have selected and the actual tattoo when applied to the body. I understand that over time, the colors and clarity of my tattoo will fade due to unprotected exposure to the sun and naturally occurring dispersion of pigment under the skin.
-I understand that 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 the exact appearance before being tattooed.
– I release the right to any photographs taken of me or my tattoo and give consent in advance to the reproduction in print or electronic media. (If you do not give consent, do not initial this box and inform the Tattoo Studio NOT to take any pictures of you or completed tattoo.
– I agree that the Tattoo Studio has a NO REFUND policy on tattoos and I will not ask for a refund, either partial or in full for any reason whatsoever.
-I agree to reimburse the Tattoo Studio for any attorney/court costs or fees incurred in any legal action I bring against the Tattoo Studio an in which either the Artist or Tattoo Studio is the prevailing party. I agree that the courts located in Pinal county within the State of Arizona shall have jurisdiction and venue over me and shall have exclusive jurisdiction for the purposes of litigating any dispute(s) arising out of this agreement.
REINKARNATE TATTOO TATTOO CONSENT FORM
-I acknowledge that I have been given adequate opportunity to read and understand this document and it was not presented to me in haste/last minute and fully understand that I am signing a legal contract waiving certain rights to recover damages against the Artist or Tattoo Studio.
If any provision, section, subsection, clause or phrase of this consent/release form is found to be unenforceable or invalid, that portion shall be severed from this contract. The remainder of this contract will then be construed as thorough and any unenforceable portion has never been contained in this document.
I hereby declare that I am of legal age (and provided a valid proof of age/identification) and I am competent to sign this agreement.
I HAVE READ THE AGREEMENT, AND UNDERSTAND THE CONTENTS WITHIN IT, AND I AGREE TO BE BOUND BY IT FROM THE DATE OF MY SIGNATURE.
Signature:____________________________________
Print Name: ____________________________________ Date:______________
Date of Birth:______________ Phone number_________________ Address:_____________________________ City:________________ Form of Identification: __________________________
State:_____
***REINKARNATE Tattoo agrees that confidential information received from its clients shall be treated as private, and safeguarded with all reasonable means. REINKARNATE Tattoo will not make public or intentionally disclose its clients’ confidential information to any third party without first receiving authorization.
———————–Do not write below this line/Tattoo Artist will record this information————————
Disclosure: REINKARNATE Tattoo Used Single Use, pre-sterilized/pre-packaged equipment.
INK COLORS USED FOR TATTOO: