May 24, 2021
Creative Ink Client Consent Form
Below is a copy of our Creative Ink consent form for your reference. For appointment holders, please fill out (digitally or print it out) and email back to us prior to your appointment.
CONSENT TO TATTOOING, WAIVER & RELEASE OF LIABILITY – CREATIVE INK, LLC. –
Name:____________________________________/_______________________________/_________________________________________________________
(Last) (First) (Middle) (Age) (Date of Birth)
Address:_____________________________________________________________________________________________(_______)_______-______________
(Street) (Phone)
______________________________________________________________________________________________________________________________________
(City) (State) (Zip)
PLEASE ANSWER THE FOLLOWING QUESTIONS:
– Are you prone to fainting? Yes___ No___
– Do you take blood thinner? Yes___ No___
– Do you have any allergies, such as latex?
If so, please list them: ______________________________________________________________________
Agreement between Creative Ink, a New Hampshire Limited Liability Company, LLC, (hereinafter “CREATIVE”), and _______________________ (hereinafter “CUSTOMER”). For and in exchange of the mutual promises contained herein, which both parties agree constitute good and sufficient mutual consideration, the parties hereby agree to the following terms and conditions (initial next to each):
Notice & Understanding of Risks: CUSTOMER agrees that he/she has been fully informed of the inherent risks associated with being tattooed. These risks, both known and unknown, including but not limited to; infection, scarring, allergic reactions, some of which may lead to serious injury and/or death. CUSTOMER has been informed of the potential risks and CUSTOMER still wishes to proceed with tattoo and CUSTOMER freely and voluntarily accepts and assumes any and all risks. _____
Waiver & Release: CUSTOMER agrees not to sue, hold harmless and further agrees to waive and release CREATIVE from all negligence and liability whatsoever to the fullest extent permitted by law, 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 tattoo. CREATIVE is not a medical professional. _____
Hourly Rate: CUSTOMER agrees to pay CREATIVE an hourly rate of $_____/hr or a flat rate of $_______ for the tattoo. _____
Questions & Discussion: CUSTOMER agrees that he/she has been given the full opportunity to ask any and all questions about the tattooing procedure and to discuss any and all potential problems or issues. Any questions asked by CUSTOMER have been answered satisfactorily. _____
Standard of Care: CREATIVE affirms that CUSTOMER will be tattooed using the appropriate instruments, equipment and techniques. CUSTOMER understands that if his/her skin pigment is dark, colors will not appear as bright as they do on light skin. CUSTOMER agrees that any touch up work needed will be done at his/her expense.____
Care Instructions: CUSTOMER acknowledges receipt of the care instructions and agrees to follow them. CUSTOMER understands that a tattoo can become infected, among other risks, if instructions are not followed completely. These instructions do not constitute medical advice and should not be substituted for medical advice._____
Intellectual Property Rights: CUSTOMER agrees and understands that all rights to designs remain the property of CREATIVE until completion of tattoo. I agree to allow CREATIVE to photograph this tattoo for any and all uses such as publication, advertisement and all other uses. _____
Sobriety & Legal Age: CUSTOMER affirms that he/she is at least 18 years of age and not under the influence of alcohol or controlled drugs, or prescription medicine that affects decision making ability._____
Good Health: CUSTOMER affirms that he/she does not have diabetes, epilepsy, hemophilia, a heart condition or any contagious or communicable diseases. CUSTOMER does not take blood thinning medication. CUSTOMER does not have any medical or skin condition which may affect the tattoo or interfere with the healing procedure. CUSTOMER is not the recipient of an organ or bone marrow transplant, or if CUSTOMER is, CUSTOMER has taken the prescribed preventative regimen of anti-biotics that is required by his/her doctor. CUSTOMER is not pregnant or nursing._____
Permanency: CUSTOMER agrees and understands that a tattoo will result in a permanent change of appearance and that CUSTOMER’s skin will never be restored to its pre-tattooed condition even after removal._____
Termination of Agreement: CUSTOMER agrees and understands that this agreement is a mutual agreement between the parties and that either party can terminate the agreement at any time in good faith. This includes instances when there are disagreements about the design. In the event that either party terminates this agreement, CREATIVE will be entitled to fair compensation for design/tattoo work already completed at the hourly rate. For situations involving deposits, please see “Creative Ink Tattoo Deposit Slip.” _____
Severability: If any clause or provision herein shall be adjudged invalid or unenforceable by a court of competent jurisdiction or by operation of any applicable law, it shall not affect the validity of any other clause or provision, which shall remain in full force and effect._____
Governing Law: This agreement contract shall be governed by the laws of the State of New Hampshire without regard to the place of execution or place of performance._____
Attorney’s Fees: In any action arising out of this agreement, CREATIVE shall be entitled to recover its attorney’s fees and expenses incurred in such action if it is the prevailing party._____
Waiver of Breach: The waiver by CREATIVE of a breach of any provision of this agreement shall not operate or be construed as a waiver of any subsequent breach._____
Jurisdiction: CUSTOMER agrees and understands that in any legal action brought against CREATIVE by CUSTOMER, CUSTOMER submits to personal jurisdiction in Cheshire County, New Hampshire, USA, and that venue and exclusive jurisdiction to hear all legal actions shall be in Cheshire County, New Hampshire, USA, without regard to the place of execution or place of performance.____
Complete Agreement: This agreement may not be modified, changed or altered by any promise or statement by whomsoever made; nor shall any modification of it be binding upon CREATIVE until such written modification shall have been approved in writing by CREATIVE. The only exception to this clause is the “Creative Ink Tattoo Deposit Slip” which is also part of this agreement but signed only by CUSTOMER.____
I have fully read and understand all the terms of this agreement. I agree to abide by the terms and acknowledge that I am of sound mind in making this agreement without duress and of my own free will.
CUSTOMER: PICTURE OF I.D:
Signature: ____________________________________________ ┌ ┐
Print Name:___________________________________________
Date: _____________________
