CONSENT FORM Jovan Janelle (Ink and Artistry LLC) First and Last Name * DOB * Phone * Email * Street Address * City * State * Zip Code * Have you been tattooed before? * Yes No Are you under the influence of drugs or alcohol? * Yes No Are you pregnant or breastfeeding? * Yes No Do you have a heart condition? * Yes No Do you have a communicable disease? * Yes No Are you currently on any medications that may interfere with the ability to get tattooed? * Yes No Are you a hemophiliac? * Yes No Do you get keloids? * Yes No Are you epileptic? * Yes No Do you have diabetes? * Yes No Do you have a tendency to faint? * Yes No I release the right to any photographs taken of me and tattoo and give consent in advance to their reproduction in print or electronic form. * Yes No Do you have any known allergies to latex and/or adhesives? * Yes No If you have any allergies or sensitivities other than latex or adhesives, please list here. * Terms and Conditions * In consideration of receiving a tattoo from Jovan Janelle (Ink and Artistry LLC) (hereinafter referred to as the "Tattoo Artist”) I agree to the following: 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. I WAIVE AND RELEASE to the fullest extent permitted by law, the Tattoo Artist, 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 Artist, or otherwise. The Tattoo Artist has given me the full opportunity to ask any question about the procedure and application of my tattoo and all of my questions, if any, have been answered to my total satisfaction. The Tattoo Artist has given me instructions on the care of my tattoo while it's healing. I understand and will follow them. I acknowledge that it is possible that the 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 am voluntarily submitting to be tattooed by the Tattoo Studio without duress or coercion. The Tattoo Artist is not responsible for the meaning or spelling of the symbol or text that I have provided to them or chosen from the flash (design) sheets. I understand that if I have any skin treatments, laser hair removal, plastic surgery or other skin altering procedures, it may result in adverse changes to my tattoo. 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. 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 a 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. I acknowledge I am over the age of eighteen and that I have truthfully represented to my tattooist that the obtaining of a tattoo is by my choice alone. I consent to the application of the tattoo and to any actions or conduct of the representatives and employees of the tattoo shop reasonably necessary to perform the tattoo procedure. I hereby release and forever discharge and hold harmless the Tattoo Artist (Jovan Janelle/Ink and Artistry LLC) 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 in my performing my tattoo, to the fullest extent allowed by the law. By signing below, I agree that I have read the Tattoo release form provided by Jovan Janelle (Ink and Artistry LLC) and agree to its terms. I accept the Terms & Conditions Date * MM DD YYYY Signature * Thank you!
