Peace Machine Tattoo Consent Form

ALLERGIES:

I acknowledge that infection is always possible as a result of the obtaining of a tattoo, particularly in the event that I do not take proper care of my tattoo. I have been given aftercare instructions and I agree to follow them while my tattoo is healing, I agree that any touch-up work needed due to my own negligence, will be done at my own expense. I acknowledge that it is not reasonably possible for Peace Machine Tattoo or Kayla Clermont 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. Furthermore, if I am concerned about allergies, I have to consult my doctor and I am unaware of any allergies to any pigments, ink, metals, bandages, or any other products used in the process of tattooing. If I have any allergies, I have stated them in the space provided below:

STATE OF MIND:

I acknowledge that 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 tattoo done at this time. I understand that tattoos are permanent and cannot be removed.

LIABILITY:

I hereby agree to waive and release Peace Machine Tattoo and Kayla Clermont from any liability, claims, damages, and legal actions arising out of or in any way related to this procedure including but not limited to: personal injury or otherwise, direct/indirect consequential damages caused by Peace Machine Tattoo or otherwise. I will not hold Peace Machine Tattoo or Kayla Clermont responsible for any of the work performed on me today. I acknowledge that this is the tattoo that I have requested; I have seen the artwork and/or the stencil when it was placed on my body and have acknowledged that all spelling is correct, this is the artwork I requested and have asked any and all questions I might have about the artwork/stencil, and if I am not sure I will say something to my artist.

CLIENT RESPONSABILITY:

I ACKNOWLEDGE THE FOLLOWING:

·       If I have any condition that might affect the healing of this tattoo, I will advise my tattoo artist

·       I am not pregnant or nursing

·       I am not under the influence of alcohol or drugs

·       I do not have any communicable disease such as HIV/AIDS, HEP A/B/C, or any other strains, etc. If I have any of the above or other infections, I will advise my tattooer

·       I have been given the full opportunity to ask any and all questions which I might have about the obtaining of a tattoo and that all of my questions have been answered to my full satisfaction

·       I do not suffer from diabetes, epilepsy, hemophilia, heart condition(s), I do not take blood thinning medications, nor do I have any other medical or skin condition that may interfere with the procedure, application, or healing of the tattoo. I am not the recipient of an organ or bone marrow transplant 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 and that I have been given the opportunity to advise Peace Machine Tattoo of such matters.

·       I have been fully informed of the inherent risks associated with getting a tattoo. I fully understand that these risks, known and unknown, can lead to injury including but not limited to: infection, scarring, and allergic reactions. 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 as a result of this procedure

·       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

PHOTOGRAPHS:

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 initial this provision, you are permitting Peace Machine Tattoo and Kayla Clermont to take photos of you and your tattoo. If you do not initial this provision, please advise the Tattoo Studio NOT to take any pictures of you and your completed tattoo. I release the right and I ALLOW Peace Machine Tattoo to take photos of me or my tattoo.

LEGAL CONTRACT:

I acknowledge that I have been given adequate time and opportunity to read and understand this document. I have asked any and all questions I might have regarding this document. I understand that I am signing a legal contract waiving certain rights to recover damages against Peace Machine Tattoo and Kayla Clermont. I herby declare that I am of legal age and have provided valid proof of age and identification and am competent to sign this Agreement.

FOR ARTIST USE ONLY: