Consent Form

Artist

Date

First name

Last name

Email

Yes, I’d like to receive occasional emails from Rose of the West Tattoo with updates, featured artwork, and upcoming events.

Date of birth (Must be 18 & over)

Month

Day

Year

Address

City

State

Zip

Location & Description of Tattoo

Allergies:

Medications:

Closest hospital/Primary care physician

Do you have any medical conditions? Heart disease, high blood pressure, allergies? If so, please explain below.

No

Yes

Other

I have been fully informed of the risks associated with getting permanently tattooed. I fully understand these risks, both known & unknown can lead to injury, including but not limited to infection, scarring, difficulties detecting melanoma, an allergic reaction to tattoo pigments, surgical steel, latex or nitrile gloves, soap, iodine, or other sterilizing products. I still wish to proceed with the tattoo procedure and freely accept any and all risks that may arise from the tattoo.

I waive and release to the fullest extent permitted by law, which includes both the artist and Rose of the West Tattoo from all liability for any and all claims or cause of action that I, my estate, heirs, executors, or assigns may have from personal injury or otherwise, including any direct and/or consequential damages, which result from the application of the tattoo, whether caused by negligence or caused by the artist, Rose of the West Tattoo or otherwise.

Both the artist and Rose of the West Tattoo have given me the full opportunity to ask all questions about the procedure. Those questions were answered to my total satisfaction. I have been given verbal and written instructions on how to care for my tattoo. If any additional work is required due to my negligence in the aftercare procedure, I agree it will be at my own expense.

I do not and have not had a fever in the last three weeks.

I am NOT under the influence of alcohol or drugs and I am voluntarily submitting myself to be tattooed by the artist without duress/coercion.

I acknowledge that I have received the tattoo aftercare and understand the importance of this information and will follow it or ask any questions I do not understand. I take it upon myself to make sure I take proper care of my tattoo.

I acknowledge a tattoo is a permanent change to my appearance and may be removed by laser or surgical means, which can scar and is costly. It will NOT restore my skin to its original appearance.

I acknowledge variations in color may exist between the tattoo I have selected and the actual completed tattoo when it is applied to my body. I agree with the artist's interpretation.

I acknowledge that the obtaining of the tattoo is by my choice alone. And the representatives and artists at Rose of the West Tattoo will have my full permission to use any actions or conduct necessary to perform the tattoo procedure.

Neither the artist nor Rose of the West Tattoo is responsible for the spelling or meanings associated with the design/tattoo I have chosen.

I acknowledge that my tattoo may take several sessions to complete, and that I acknowledge and consent to all of the above information for my appointments to follow.

I release all rights to any photographs taken of me and the tattoo and I give consent in advance to their reproduction in print and electronic form.

I acknowledge that I have been given adequate opportunity to read and understand this document, and that it was not presented to me at the last minute or after the procedure. I understand that I am signing a contract waiving certain rights to recover against the artist or Rose of the West Tattoo if my tattoo appears to be infected, I will contact my artist and then my physician.

Upload Official ID

Initials

Signature

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I acknowledge that all information on this form is true and truthfully represented to all parties associated with Rose of the West Tattoo, and that by signing this I have been given the full opportunity to ask any and all questions regarding getting a tattoo at Rose of the West Tattoo. That all questions have been answered to my full and complete satisfaction.