CONSENT TO APPLICATION OF TATTOO AND RELEASE AND WAIVER OF ALL CLAIMS Tattoos by Scarlett Winters Ketchikan AK-Client Consent Waiver- Studio Location RainCity Tattoo, Ketchikan AK Wanderlust Ink Co. Roseville CA All Fields MUST be filled out Prior to Tattoo Procedure - ThankYou! Tattoos By Scarlett Winters - akartbyscarlett.com First Name Last Name Email (optional) Phone Number (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country DEPOSIT None $50 $100 $150 $250 OTHER Tattoo Description & Placement I Am 18 years or older * Yes No Date of Birth * MM DD YYYY ID Type & Number Do you have any allergies to the following? Latex Soaps Metals Antibiotics Cosmetics Alcohol Other Allergies Are you currently? Pregnant Breastfeeding Taking Blood Thinners or have Hemophilia Have a Heart Condition On any Medication(s)? Medication Type(s) Do you have now or have you ever had? Hepatitis Herpes HIV Staph MRSA Syphilis Gonorrhea Chlamydia Covid Tuberculosis Fainting or Dizziness High Blood Pressure Subject To Rashes Sensitive Skin Cellulitis IV Drug Use Diabetes Epilepsy Eczema Other Health History Other blood borne pathogens, Skin Conditions, Heath Diagnosis, etc... I acknowledge by initialing and submitting this waiver that I have been given full opportunity to ask any and all questions I might have about obtaining a tattoo from my artist: and that all my questions have been answered to my full and total satisfaction. I specifically acknowledge that I have been advised of the facts and matters set forth below, and by my initials I agree as follows: Project Notes: Name & Initials 1. I acknowledge that it is not reasonably possible for my artist to determine whether I might have an allergic reaction to the dyes, pigments or processes used in my tattoo, and I agree to accept the risk that a reaction is possible. 2. I acknowledge that infection is always possible, particularly in the event that I do not take proper care of my tattoo 3. I acknowledge receipt of written instructions advising me of the proper care of my tattoo and I recognize the absolute necessity for following those instructions. 4. I realize the variations in color and design may exist between any tattoo represented on paper selected by me and as ultimately applied to my body. 5. I acknowledge that a tattoo is considered permanent, that it can only be removed by a surgical procedure , that any removal may leave scarring an permanent disfigurement. 6. I acknowledge that I truthfully represented to my artist that I am over the age of eighteen (18)years old.(please show identification to tattooist upon submission of this form. 7. I acknowledge that the obtaining of my tattoo is by my choice alone and I consent to the application of the tattoo. 8. I acknowledge that I am not under the influence of drugs or alcohol or any intoxicating substance at the time the tattoo is administered 9. I hereby give my artist permission to copyright and/or use and/or publish photographic portraits or pictures of me in which I may be included in whole or part or reproductions thereof made through any media & social media for art, advertising or any other lawful purpose whatsoever. I waive any right I may have to inspect and/or approve the finished product or the use to which it may be applied. 10. I agree to release and forever discharge and hold harmless my artist and the studio in which my tattoo is applied 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 to apply my tattoo or the processing or production of any said pictures. Printed Signature acknowledging consent to this form : Today’s Date MM DD YYYY - Tattoo AfterCare - Only ever handle your new tattoo with freshly washed hands. Do not let other people or pets come into contact with your new piece. If black bandage has been applied wear overnight and remove in the morning. If clear bandage has been applied keep on 24 to 36 hours and remove slowly peeling from one corner while slightly running under cool water to help release the adhesive. Wash your new tattoo 3x/day using gentle circular motions under cool running water with a small amount of antibacterial soap. Dial gold original or similar is reccomended. Pat dry with clean paper towel and let air dry for 10 minutes. Re-Wash immidiately if your tattoo comes into contact with contaminents like sand/dirt, oils perfumes, public surfaces or excessive sweat. First 7-10 days Apply very thin layer of tattoo safe ointment like aquaphor, a&d devils club, tattoo goo, etc. Do not use vasaline. Re-apply 5x per day or when tattoo feels dry from last application. After 10 days switch to a light non-scented cream based lotion 4-5x day to keep your tattoo hydrated while healing, but still allowing the skin to breathe. Do not wear clothing that is constricting or abrasive against your new tattoo while healing. Do not Work Out/Sweat excessively for at least 14 days after. Do expose to contact with chlorinated water for 30 Days. Do Not expose your tattoo to excessive sunlight for 30 days. THE PROTECTIVE LAYER OF SKIN DOES NOT FULLY HEAL BACK UNTIL ~28 - 30 days. To further protect your tattoo after the healing process moisturize regularly and always apply sunscreen when exposing to prolonged sunlight. Following Aftercare is vital to proper healing & lasting quality of your tattoo. Not following aftercare leaves you vulnerable to ink fall out, line blow-outs, fading, scarring and infections. Please be mindful of the importance of aftercare, as tattoo touchups are not free I have read and understand the aftercare instructions. Thank you your tattoo consent form has been completed! Please return ipad and photo ID to Staff for final review.
