Tattoo & Body Piercing Consent Form

 

______ - 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.

 

______ - 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.

 

______ - I release the right to any photographs taken of me and the tattoo and give consent in advance to their reproduction in print or electronic form. (For assurance, if you do not initial this provision, please inform the Tattoo Studio NOT to take any pictures of you and your completed tattoo).

 

______ - I agree that the Tattoo Studio has a NO REFUND policy on tattoos, piercing and/or retail sales and I will not ask for a refund for any reason whatsoever.

 

______ - I agree to reimburse the Tattoo Studio for any attorneys' fees and costs incurred in any legal action I bring against the Tattoo Studio and in which either the Artist of the Tattoo Studio is the prevailing party. I agree that the courts of located in the County of _______________ within the State of _______________ shall have jurisdiction and venue over me and shall have exclusive jurisdiction for the purposes of litigating any dispute arising out of or related to this agreement.

 

______ - I acknowledge that I have been given adequate opportunity to read and understand this document that it was not presented to me at the last minute and grasp that I am signing a legal contract waiving certain rights to recover damages against the Tattoo Studio.

 

If any provision, section, subsection, clause or phrase of this release 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 though the unenforceable portion had never been contained in this document.

 

I hereby declare that I am of legal age (and have provided valid proof of age and identification) and am competent to sign this Agreement.

 

I HAVE READ THE AGREEMENT, I UNDERSTAND IT, AND I AGREE TO BE BOUND BY IT.

 

Signature __________________________

 

Print: ______________________ Address: ___________________________________

 

Date of Birth: ___/___/___            City: ___________________ State: ______________

 

Form of Identification: __________________________

 

PARENTAL / GUARDIAN CONSENT FOR TATTOO

 

 

 

State of _______________________ }

 

County of ______________________ } Ss:

 

 

___________________________________________________________________________ (Print Name of Parent or Legal Guardian)

 

Residing at: _________________________________________________________________.

 

HEREBY SWEARS OR AFFIRMS UNDER PENALTY OF PERJURY, that the

following facts as stated in this document are true:

 

 

1)      I am the natural parent or legal guardian of: __________________________________

                        (Print Name of Minor Child)

 

2) The Minor Child’s date of birth is: ____________________________, 20_____

           (Month)                      (Day)           (Year)

3) The child’s age is: _______.

 

4) I have the legal authority to give consent for this child’s Tattoo.

 

5) I consent to the tattooing of my child as follows: _______________________________

 

________________________________________________________________________.

(Description and Location of Tattoo on Child)

 

_______________________________

Signature of Parent/Legal Guardian

 

(IF REQUIRED)

 

SWORN TO, OR AFFIRMED, IN PERSON BEFORE ME, this _____ day of

 

__________________, 20____, by __________________________________ who is

(Print Name)

 

personally known to me, or, who produced satisfactory identification in the form of

 

_________________________________________________________________________

 

 

_______________________________

(Signature of Notary)                                                                         SEAL:

 

_______________________________

(Print Name of Notary)

 

 

 

ADULT PIERCING CONSENT

 

 

I acknowledge by signing this Release I have been given the full opportunity to ask any and all questions which I might have about obtaining a piercing from ________________

(hereinafter known as the “Piercer”) and all my questions have been answered to my full and total satisfaction. I acknowledge I have been advised of the matters set forth below and I agree as follows:

 

Please Initial

 

________ - I am not pregnant or nursing. If I have any condition that might affect the healing of this piercing, I will inform my Piercer.

 

________ - I do not suffer from medical or skin conditions such as, but not limited to: keloid or hypertrophic scarring, psoriasis at the site of the piercing or any open wounds or lesions at the site of the piercing.

 

________ - I have advised the Piercer of any allergies to metals, latex gloves, soaps and medications. I acknowledge it is not reasonably possible for the Piercer to determine whether I might have an allergic reaction to the piercing or processes involved in the piercing and further acknowledge that such a reaction is possible.

 

________ - I have trustfully represented to the Piercer I am over the age of 18 years.  I am not under the influence of drugs or alcohol. 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 a piercing done at this time.

 

________ - I acknowledge that obtaining this piercing is my choice alone and will result in a permanent change to my appearance, and that no representation has been made to me as to the ability to later restore the skin involved in this piercing to its pre-piercing condition.

 

________ - I acknowledge infection is always possible as a result of obtaining a piercing.  I have received aftercare instructions and I agree to follow all of them while my piercing is healing.

 

________ - I understand I will be pierced using appropriate instruments and sterilization.

 

Therefore, I request the Piercer to pierce my ______________________.  I understand this type of piercing usually takes ______________________ or longer to heal. I agree to release and forever discharge and hold harmless the Piercer and all employees from any and all claims, damages or legal actions arising from or connected in any way with my piercing, or the procedure and conduct used in my piercing.

Dated this ___ day of _________________________, 20___

Signature: ______________________________

Name: ______________________________

Address: ____________________________________________________________

Age: ________ Drivers License # ______________________________ State: _______

 

MINOR (CHILD) PIERCING CONSENT

 

 

State of _______________________ }

 

County of ______________________ } Ss:

 

 

_____________________________________________________________________

(Print Name of Parent or Legal Guardian)

 

Residing at: ___________________________________________________________.

 

HEREBY SWEARS OR AFFIRMS UNDER PENALTY OF PERJURY, that the

following facts as stated in this document are true:

 

 

1)      I am the natural parent or legal guardian of: ____________________________

                                                                                           (Print Name of Minor Child)

 

2) The Minor Child’s date of birth is: ____________________________, 20_____

              (Month)                   (Day)               (Year)

3) The child’s age is: _______.

 

4) I have the legal authority to give consent to the body piercing of this child.

 

5) I consent to the body piercing of my child as follows: ______________________.

                                                                            (Location of Piercing on Child)

 

_______________________________

Signature of Parent/Legal Guardian

 

(IF REQUIRED)

 

SWORN TO, OR AFFIRMED, IN PERSON BEFORE ME, this _____ day of

 

__________________, 20____, by __________________________________ who is

(Print Name)

 

personally known to me, or, who produced satisfactory identification in the form of

 

______________________________________________________________________

 

 

_______________________________

(Signature of Notary)                                                                         SEAL:

 

_______________________________

(Print Name of Notary)