Tattoo Waiver Release Form

TATTOO WAVIER CONSENT & DISCOLSURE FORM

Client Information

Thank You for your interest in booking with InkySPA LLC. Please provide the following information to move forward with the booking process so that I can better assist your request. To ensure that your body art procedure heals properly, I ask that you disclose any of the following; Disclosure doesn't legally prevent you from having a body art procedure.

First name

Last name

Phone

Address

Date of birth

Month

Day

Year

Emergency Contact Name & Phone Number

Please upload a picture of your State ID, Drivers License, or Passport to verify age & identity. (*Must be at least 18 years or older to receive tattoo.)

Briefly describe what type of tattoo design you are looking to get done?

Where do you want the tattoo to be placed? ie: arm , leg , back etc.

Do you want Black & Gray or Color?

Black & Gray

Color

Both

Is this a cover up tattoo? (*please upload pic below)

Please upload an example picture of the type of tattoo you want done. Can upload up to 4 pics max. If a cover up please upload a pic what you have and what you want over it.

Size Preference (How big do you want the tattoo)?

Small (1"-4") $150 & up

Medium (4"-7") $300 & up

Large (7"-12" or larger) $600 & up

What is your budget (How much can you afford to spend)?

How did you hear about me?

What is your instagram, facebook or tik tok handle?

Appointment Date Request

Please select a date you are available to come for tattoo appointment.

MEDICAL HISTORY

If Yes any checked box please provide any details about your medical history above if none put N/A

INFORMED CONSENT TO RECIEVE SERVICES

I understand I am here to receive a Tattoo Service from Tattoo Artist Katisha Farrell at InkySPA LLC. I acknowledge the following by checking each box below:

I understand that InkySPA LLC has a zero tolerance drug & alcohol policy. I am not under the influence of any drugs or alcohol. I am of sober mind & voluntarily submit myself to receive tattoo. If any client moves excessively, causes loud noise, disrespectful, disruptive behavior during procedure you will be asked to leave InkySPA LLC can stop and refuse service at any time for any reason. NO REFUNDS for any services provided.

I am not under duress or coercion. I willfully submit myself to receive tattoo.

I understand there is a risk of hyperpigmentation when receiving a tattoo. I understand this is rare but if occurs I understand there is no way to tell who skin will react this way. I agree this is not intentionally caused by my tattoo artist therefore understanding they are not legally liable.

I agree to protect my tattoo in the sun with sunscreen, depending on area of the tattoo. I understand if I expose my tattoo to sun or tanning booth, it may fade or cause discoloration of tattoo.

I understand there is a risk I may feel dizzy, lightheaded or tired during the procedure. I agree to notify my technician immediately if this occurs

I understand tattoos are permanent and may only be laser removed or cover up.

I agree to inform my tattoo artist of any changes to tattoo before the procedure begins. I acknowledge before the tattoo procedure starts, I have agreed to the shape, location, design and color of tattoo therefore, giving my tattoo artist permission to start the procedure.

Katisha Farrell (InkySPA LLC) is not responsible for the meaning or spelling of the symbol or text that I have provide 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 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 understand that the quality of work can differ based off of quality, age, texture of skin, experience of technician & how well I take care of my tattoo.

The signs of infection are as follows (but not limited to): Redness, abnormal swelling, warm to touch, discharge or extreme scabbing. I understand there is a possibility of infection if I fail to follow proper aftercare instructions. I agree to seek proper medical attention if a infection occurs.

I understand there is a risk of an allergic reaction. Signs & Symptoms of a reaction are (but not limited to): red, bumpy, itchy skin. If this occurs, I agree to seek proper medical care.

All questions about the tattoo procedure have been answered to my satisfaction, and that I have been given aftercare instructions for the procedure I am about to receive. Click here for aftercare instructions Tattoo Aftercare

I release the right to any photographs and or videos taken of me and the tattoo and give consent in advance to their reproduction in print or electronic form social media etc. (If you don't want any pics taken please let the artist know before the procedure starts.)

I agree that Katisha Farrell (InkySPA LLC) has a NO REFUND Policy on All Services Tattoos, Waxing, Facials and-or retail sales and I will not ask for a refund for any reason whatsoever.

I agree to reimburse Katisha Farrell (InkySPA LLC) for any attorneys' fees and costs incurred in any legal action I bring against Katisha Farrell (InkySPA LLC.) and in which Katisha Farrell (InkySPA LLC) is the prevailing party. I agree that the courts of Chicago, IL Cook County shall have personal jurisdiction and venue over me and shall have exclusive jurisdiction for the purposes of litigating any dispute arising out of or related to this agreement.

I WAIVE AND RELEASE to the fullest extent permitted by law Katisha Farrell (InkySPA LLC) 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 procedure and application of my tattoo, whether caused by the negligence or fault of Katisha Farrell (InkySPA LLC.)

I Release Tattoo Artist Katisha Farrell and InkySPA LLC from any legal liabilities from the prior releases I checked above. Tattoo Artist nor establishment is responsible for any infection caused from my lack of proper disclosure, aftercare, hyperpigmentation, allergic reaction, medical issues that may arise from falsified information I provided on this form.

I agree to InkySPA LLC. Terms & Conditions. Click to view Terms & Conditions

Signature

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by checking the boxes & signing above, I acknowledge the information I provided on this form is true & accurate to the best of my knowledge. I understand if I did not answer any questions truthfully, nor the technician or establishment is responsible for any negative outcome.