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CONSENT TO TATTOO & RELEASE OF CLAIMS

I acknowledge by signing this release I have been given the full opportunity to ask any and all questions which I might have about obtaining a tattoo or any other body art related work from Ventura Tattoo and Piercing and all my questions have been answered to my full and total satisfaction. I acknowledge I have been advised of the matters set forth above and I agree as follow.

I Agree

I, being of sound mind and body, hereby release any and all persons, agents and/or employees representing Ventura Tattoo and Piercing from any and all responsibilities. I, alone, accept any body art related procedure done by Ventura Tattoo and Piercing.

I Agree

I agree not to sue Ventura Tattoo and Piercings agent(s), owners, employees or persons representing Ventura Tattoo and Piercing in connection with any and all damages, demands, claims, rights and causes of action of any kind based upon injuries, property damage, or death of myself arising from any decision to have body art related work at this time. Whether or not caused by negligence of agents, owners, employees or persons representing Ventura Tattoo and Piercing.

I Agree

I agree for myself, my heirs, assigns and legal representatives to hold person(s), agent(s), owners and employees of Ventura Tattoo and Piercing harmless of any and all damages, actions, causes of actions, claims judgment, costs of litigation, attorney fees and all expense(s) that might arise from my decision to have any body art related work done at Ventura Tattoo and Piercing.

I Agree

I agree to follow all instructions concerning the aftercare of a my new tattoo while it is healing. I understand fully that if I do not keep my tattoo clean, my tattoo is susceptible to infection including staphylococcus bacterial infection. I agree that any further services needed, due to my negligence, will be done at my expense. Further, I understand that tattoos are considered PERMANENT.

I Agree

I hereby give Ventura Tattoo and Piercing permission to copywrite and or publish photographs of the body art related work performed on myself by Ventura Tattoo and Piercing, without compensation. I fully understand that, per California State Law, I must be 18 years of age or older to receive a tattoo and I am 18 years of age or older as of today's date.

I Agree

 

First Client's Name

First Name*

Last Name*

Phone*
First Client's Date of Birth*
First Client's Information

Preferred Name (If different from legal name)
Are you over the age of 18 years old?*
Yes
No
First Client's Signature*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Name of Tattoo Artist for your upcoming visit
I represent and warrant to Ventura Tattoo and Piercing that the following is true and correct. *
Yes
DO YOU CURRENTLY HAVE OR HAVE A HISTORY OF THE FOLLOWING?
(Please understand that by failing to answer the following correctly, you could drastically affect how your tattoo heals)
Diabetes
Communicable Disease(s)
Hemophilia
Skin diseases/lesions
Staphylococcus
MRSA
Bacterial Infections
Heart Conditions
Epilepsy
Seizures
Fainting
Narcolepsy
Hepatitis C
AIDS/HIV+
Whining
Tourettes
High Blood Pressure
Kelioding
Hypertrophic Scarring
Psoriasis
Cold Sores
Heavy Bleeding
PLEASE COMPLETE THE FOLLOWING:
Are you currently under the influence of any drugs or alcohol?*
Yes
No
Have you been drinking alcohol within the last 8 hours?*
Yes
No
Are you currently pregnant?*
Yes
No
Are you currently taking any anticoagulants or medication that thins the blood and or may interfere with blood clotting?*
Yes
No
Have you eaten within the past 4 hours?*
Yes
No
I understand that the tattoo artist cannot be held responsible if my body reacts negatively to the ink.*
Yes
No
I understand that the tattoo artist suggestions are not to be confused with medical advice.*
Yes
No
I understand that I am totally responsible for looking after my tattoo.*
Yes
No
I understand that sterilized equipment and/ or single use disposables will be used for my tattoo.*
Yes
No
I understand that it is my responsibility alone to check for accuracy of spelling on words, as well as any times or dates that I want included in my tattoo. *
Yes
No
I understand that the ink used in tattooing is not one approved by the F.D.A.*
Yes
No
I understand that my artist is not responsible for how any numbing cream I apply affects my tattoo and how it heals. I also agree to let my artist know if I have applied any numbing cream before I arrive. *
Yes
No
ANY KNOWN ALLERGIES OR REACTIONS TO:
Pigments or Dyes
Disinfectants
Latex
Metals
Soaps
Price Agreement

Price Quoted *
I agree to pay the price given to me by my artist. *
By checking this box I understand and accept this statement.
I understand that any changes or additions made after my initial quote will be an additional cost. *
By checking this box I understand and accept this statement.
Aftercare
All of our aftercare instructions are listed at https://www.venturatattoos.com/aftercare *
I am aware that I can access the aftercare instructions on the website, and also will be given a paper copy following my appointment.
I understand that I can ask my artist any questions I have regarding aftercare.
Parent or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Preferred Name (If different from legal name)
Are you over the age of 18 years old?*
Yes
No
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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