Date of your tattoo session:*

Date

Artist you are being tattooed by:*

Amelia

Today's Date*

Date

Full Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Birth Date*

MonthDayYear

Pronouns:

E-mail

Please read through and select "yes" or "correct" to acknowledge that you have read and agree to our terms:

I have been informed of the nature, risks and possible complications and consequences of permanent skin pigmentation. I understand the permanent skin pigmentation procedure carries with it knowing and unknown complications and consequences associated with minor invasive skin treatments including but not limited to infection, scarring, inconsistent color, pigment migration, fanning and fading. Cornea abrasions are a rare side effect, especially if I rub or scratch my eyes or apply contacts too soon after an eyeliner procedure. I understand the actual color of the pigment may be slightly modified due to the tone and color of my skin. I fully understand this tattoo is a process and therefore not an exact science, but an art. I request the permanent skin pigmentation procedures, and accept the permanence of the procedure as well as the possible complications and consequences of all the cosmetic tattoo procedures.*

yes

I understand that I must wear a face mask or face covering in front of my nose and mouth while at Liquid Amber Tattoo at all times. If I am feeling any respiratory issues, have a fever, or flu/common cold symptoms I will not come into the studio and will give as much notice as possible to reschedule my appointment.

yes

I waive and release to the fullest extent permitted by law each of the Artist and Liquid Amber Tattoo 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 cosmetic tattoo, whether caused by the negligence or fault of either the Artist or Liquid Amber Tattoo, or otherwise.*

yes

Both the Artist and Liquid Amber Tattoo 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 complete satisfaction.*

yes

The Artist has 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. I understand that I am fully accountable for post care treatment and the effect it will have on the heal-out of my cosmetic tattoo and will adhere strictly to my aftercare instructions.*

yes

During my tattoo session, I will not be not under the influence of alcohol or drugs, and I am voluntarily submitting to be tattooed by the Artist without duress or coercion.*

correctOther

I am aware that variations in color and appearance of my cosmetic tattoo are part of the healing process and may occur. I am aware that cosmetic tattoos will vary in appearance and color during the healing process and am prepared that my cosmetic tattoo while healing will potentially be raised, darker in color, lighter in color, have flaking, scabbing and visible fluid as part of the body's natural healing process. I also understand that over time, the colors and the clarity of my cosmetic tattoo will fade due to unprotected exposure to the sun and the naturally occurring dispersion of pigment under the skin. I understand I can ask the Artist or Liquid Amber Tattoo about any aftercare questions.*

yes

I understand that although this is a cosmetic tattoo with semi permanent ink it must be considered a permanent change to my appearance and can only be removed by laser or surgical means if it does not fade away completely through the body's natural metabolic process, 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 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 cosmetic tattoo. I acknowledge some of these potential adverse changes may not be correctable*

yes

Please check any of the following conditions that apply to you and/or elaborate further below.*

List any allergies you may have.

List any medications you are taking.

Please list any cosmetic services you have received that are in the same area as your cosmetic tattoo such as Botox, Fillers, Facial surgeries within the past 6 weeks or may be preparing to have within 6 weeks.

I do not have any other medical or skin conditions that I have not listed above that may interfere with the application or healing of the tattoo. I am not pregnant or nursing. I do not have a mental impairment that may affect my judgment in getting the cosmetic tattoo. I understand that if I am prone to cold sores and receive a lip cosmetic tattoo that I will take oral medication such as Valtrex as prescribed by a physician to prevent a severe cold sore outbreak in the lip area. I am aware that I must take this medication on the day and the following day after my lip cosmetic tattoo.*

correctOther

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. Please note: If you do not initial this provision, please advise and remind your Artist and Liquid Amber Tattoo not to take any pictures of you and your completed tattoo.*

yesno

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 or will provide valid proof of age on the day of my tattoo) and am competent to sign this Agreement.

I acknowledge that I have been given adequate opportunity to read and understand this document, and I understand that I am signing a legal contract waiving certain rights to recover against the Artist and Liquid Amber Tattoo.*

yes

Signature*

Client Waiver, Release & Consent to Tattoo