𝕭𝖑𝖆𝖈𝖐 𝕺𝖓𝖞𝖝 𝕰𝖒𝖕𝖎𝖗𝖊 𝕿𝖆𝖙𝖙𝖔𝖔
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Tattoo Waiver
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This Section to be filled out by a Staff Member
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Indicates required field
Copy of ID (Ensure the client is at least 18)
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Max file size: 20MB
Staff Member
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Sosa
Peach
Wero
Guest Artist
Procedure
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Tattoo
Microblading/Microneedling
Tattoo Removal
SMP
Tattoo brightening
Tattoo/Procedure Description (Be specific)
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Body Location (Question Marks void your liability protection)
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Procedure Cost (USD)
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I agree.
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I agree to the above described price or hourly fee. Services rendered are non-refundable. I have had reasonable time to consider and understand the cost of the procedure and hold no harm to Black Onyx Empire or it’s contracted artists responsible for reimbursement if I am later unsatisfied with pricing. I, the client, understand this and by choosing ‘I AGREE’, I agree to the above noted price and or fee.
Does the Client have a Coupon/Gift Card? (If unsure, ASK)
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Yes
No
Client Section:
Legal First and Last Name
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First
Last
Date of Birth (MM/DD/YYYY)
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Phone number (111)111-1111
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PLEASE READ AND BE CERTAIN YOU UNDERSTAND THE IMPLICATIONS OF SIGNING. In consideration of receiving a tattoo from (an (Apprentice) and (Black Onyx Empire Tattoo, hereafter referred to as "The Company"), (and its employees, apprentices and agents, here and after collectively referred to as “the Tattoo Studio”), I agree to the following: I,the mentioned Customer, 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, difficulties in detecting 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 still wish to proceed with the tattoo application and I 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 each of the Artist and The Company from all liability whatsoever, for 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 application of my tattoo, whether caused by the negligence or fault of either the Artist or The Company, or otherwise. Both the Artist and The Company have given me the full opportunity to ask any and all questions about the application of my tattoo and all of my questions have been answered to my total satisfaction. The Artist and The Company have given me instructions on the care of my tattoo while it’s healing, and I understand them 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 Artist without duress or coercion. I do not have diabetes, epilepsy, hemophilia, a heart condition, nor do I take blood thinning medication. I do not have any other medical or skin condition that may interfere with the 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 preventive regimen of antibiotics that is required by my doctor in advance of any invasive procedure such as tattooing or piercing. I am not pregnant or nursing. I do not have a mental impairment that may affect my judgment in getting the tattoo. Neither the Artist nor The Company is responsible for the meaning or spelling of the symbol or text that I have provided to them or chosen from the flash (design) sheets. 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 understand that tattoo inks are not FDA approved. 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 all rights to any photographs taken of me and the tattoo and give consent in advance to their reproduction in print or electronic form. (If you do not initial this provision, please advise and remind your Artist and The Company NOT to take any pictures of you and your completed tattoo!). I agree to reimburse each of the Artist and The Company for any attorneys’ fees and costs incurred in any legal action I bring against either the Artist or The Company and in which either the Artist or The Company is the prevailing party. I agree that the that the courts of the designated City and State shall have personal jurisdiction and venue over me and shall have exclusive jurisdiction for the purpose 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 I understand that I am signing a legal contract waiving certain rights to recover against the Artist and The Company.
Waiver
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I agree.
PLEASE READ AND BE CERTAIN YOU UNDERSTAND THE IMPLICATIONS OF SIGNING. In consideration of receiving a tattoo from (an (Apprentice) and (Black Onyx Empire Tattoo, hereafter referred to as "The Company"), (and its employees, apprentices and agents, here and after collectively referred to as “the Tattoo Studio”), I agree to the following: I,the mentioned Customer, 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, difficulties in detecting 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 still wish to proceed with the tattoo application and I 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 each of the Artist and The Company from all liability whatsoever, for 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 application of my tattoo, whether caused by the negligence or fault of either the Artist or The Company, or otherwise. Both the Artist and The Company have given me the full opportunity to ask any and all questions about the application of my tattoo and all of my questions have been answered to my total satisfaction. The Artist and The Company have given me instructions on the care of my tattoo while it’s healing, and I understand them 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 Artist without duress or coercion. I do not have diabetes, epilepsy, hemophilia, a heart condition, nor do I take blood thinning medication. I do not have any other medical or skin condition that may interfere with the 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 preventive regimen of antibiotics that is required by my doctor in advance of any invasive procedure such as tattooing or piercing. I am not pregnant or nursing. I do not have a mental impairment that may affect my judgment in getting the tattoo. Neither the Artist nor The Company is responsible for the meaning or spelling of the symbol or text that I have provided to them or chosen from the flash (design) sheets. 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 understand that tattoo inks are not FDA approved. 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 all rights to any photographs taken of me and the tattoo and give consent in advance to their reproduction in print or electronic form. (If you do not initial this provision, please advise and remind your Artist and The Company NOT to take any pictures of you and your completed tattoo!). I agree to reimburse each of the Artist and The Company for any attorneys’ fees and costs incurred in any legal action I bring against either the Artist or The Company and in which either the Artist or The Company is the prevailing party. I agree that the that the courts of the designated City and State shall have personal jurisdiction and venue over me and shall have exclusive jurisdiction for the purpose 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 I understand that I am signing a legal contract waiving certain rights to recover against the Artist and The Company.
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 am competent to sign this Agreement.
Compliance:
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I comply.
I hereby declare that I am of legal age (and have provided valid proof of age) and am competent to sign this Agreement. 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 am competent to sign this Agreement.
Please check if you have ANY of the following conditions AND INFORM A STAFF MEMBER IMMEDIATELY
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CARDIAC VALVE DISEASE
BLEEDING DISORDER
DIABETES
TUBERCULOSIS
SCARRING
EPILEPSY
ASTHMA
HEART CONDITION
PREGNANT/NURSING
HEMOPHILIA
HERPES
BLOOD THINNERS
SKIN CONDITION
FAINTING/DIZZINESS/VERTIGO
HIV/AIDS
I DO NOT HAVE ANY OF THE ABOVE LISTED MEDICAL CONDITIONS OR ANY OTHER CONDITIONS THAT WILL AFFECT MY PROCEDURE AND HEALING.
eSignature
The parties agree that this agreement may be electronically signed. The parties agree that the electronic signatures appearing on this agreement are the same as handwritten signatures for the purposes of validity, enforceability, and admissibility.
Please Type Your Legal First and Last Name
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First
Last
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Piercing
Piercing Waiver Form
Piercing Minor Waiver Form
Piercing Infant Waiver Form
Tattoo
Tattoo Waiver Form
Tattoo Minor Waiver Form
Tattoo Apprentice
>
Apprentice Tattoo Waiver Form
Apprentice Tattoo Minor Waiver Form
Products
Esthetics