Malicious Ink

Let us do this part

Today's Date:

Fri Nov 1 2024 06:25

Practitioner:*

Malicious Ink

Please read and answer

Are you allergic to any of the following products?*

Nuts, ie: coconut oil, macadamia nut oil, sweet almond oil? Beeswax, Aloe, Lavender, Grape Seed oil, Geranium essential oil, Chlorophyll, Cannabidiol (CBD 200MG)

Details:

Symptomatic Allergies or Signs of Sickness*

Do you agree that symptoms of illness or severe allergies will require rescheduling of your appointment? Due to health concerns, concerns for our clients, the shop environment and artists, all allergy symptoms or symptoms of being sick ie: coughing, sneezing, runny nose, sore throat etc will require the appointment to be rescheduled or stopped. Even with just having allergy symptoms this still applies because coughing and sneezing can still transmit an asymptomatic Covid-19 infection. This applies for the artist as well and may require your artists to reschedule.

Medications *

Are you currently on or taking any medications that may cause bleeding?

Details:

History of health conditions*

Do you have any medical history or health conditions / concerns that should be disclosed prior to your tattoo? Are you diabetic?

Details:

Bleeding*

Are you a hemophiliac (bleeder) or on any medications that may cause bleeding or may hinder blood clotting?

Details:

Bloodbourne Pathogens*

Do you have any bloodbourne pathogens, transmittable diseases or recent illnesses? (It' okay if you do, we just want to know for our and other's safety).

Details:

Not Pregnant*

I agree that I am not pregnant

Eaten and hydration*

Have you eaten in the past 4hrs? It's a good idea to before hand to increase your blood sugar levels as well as maintain proper hydration.

Judgement clause*

I do not have any mental, medical impairment, disability that I have not disclosed here. I am not under the influence of drugs or alcohol which may affect my well being as a direct or indirect result of my decision to have a tattoo procedure done at this time.

Risks*

That I have been fully informed of the inherent risks, associated with getting a tattoo. I fully understand that these risks, known and unknown, can lead to injury, including but not limited to infection, scarring, difficulties in detecting melanoma and allergic reactions to tattoo pigment, latex gloves, and/or soap. Having been informed of the potential risks, I still wish to proceed with the tattoo application and I freely accept and expressly assume any and all risks listed and not listed.

6 month guarantee and exclusions *

I understand and agree Un Amore INC DBA Malicious Ink tattoo artists provide 6 month guarantees on their tattoo work when and only their professional advice and aftercare is followed. If I decided to not follow their professional and experienced advice, I understand they cannot guarantee their tattoo work. I understand some tattoos require a touch-up after the tattoo is healed, and that the original tattoo artist who did the original tattoo at Un Amore INC DBA Malicious Ink will provide a touch-up at no extra cost if requested (and at artists discretion) and is scheduled within 90 days of the original tattoo session. Touch-up sessions do not include additional new work to the tattoo. I understand I get one request to book my complimentary touchup, should I cancel my touchup I understand that I forfeit my complimentary session.

I understand that Un Amore INC DBA Malicious Ink artists can NOT GUARANTEE tattoo work on the following areas of the body: Fingers, Hands, Palms, Ears, Behind the Ears, Neck, Feet, Heels, Ankles, Toes, Elbows, & Knee Caps.

I understand that Un Amore INC DBA Malicious Ink tattoo artists can NOT GUARANTEE their tattoo work if during the tattoo session I experience severe bleeding and/or swelling, or if I am unable to remain still during the tattoo - which may result in my tattoo artist ending my session early. Should this occur, I understand that my tattoo artist can NOT GUARANTEE their work and I most likely will need a second session which will be billed at their hourly rate.

Color, sun exposure and aging *

I understand that the finished tattoo may vary somewhat in appearance, color and/or design from the paper or other drawing or photographic image which the tattoo design is based.

I also understand that prolonged sun exposure can and will affect the tattoo and colors, potentially causing fading, blurred lines and colors to change.

Aging varies person to person and understand that my tattoo may require freshening up years later ( at whatever the current rate is) as my skin ages.

Symbols, Meanings, Spelling*

The artist or studio Un Amore INC DBA Malicious Ink and it’s employees / artists are not responsible for the meanings or spelling of the symbol or text that I have provided or approved prior to being tattooed.

Agreement of tattoo*

I swear or affirm and agree that the above information is true and correct. I have been provided with information describing the tattoo, seen the tattoo design and 100% give consent to receive this tattoo. I have been informed of the procedure to be preformed and am aware that I will receive instructions on aftercare following my submission of this form via email. I have been made aware that if I have any signs or symptoms of infection, such as swelling, pain, redness, warmth, fever, unusual discharge or odor to contact my physician at my own cost as Un Amore INC DBA Malicious Ink artists are not a medical physician or medical facility. It is also my responsibility to take care of my new tattoo site according to the instructions provided both verbally and in writing.

Tattoos are permanent *

I have been advised that the tattoo will be permanent and that it can't be undone and can only be removed with a surgical procedure. That any effective removal can leave permanent scarring and disfigurement. This cautionary notice is required to be provided to me by the health department and I hereby acknowledge receipt of this formal notice.

Risk*

Being of sound mind and body, I hereby release any and all employees, agents or persons representing Un Amore INC DBA Malicious Ink from all responsibility. I agree not to sue Un Amore INC DBA Malicious Ink or its heirs or assigns in connection with any and all damages, claims, demands, rights and causes of action of whatever kind or nature based upon injuries, property damages to or death of myself or any other persons arising from my decisions, behavior to have any tattoo and/or related work, whether or not caused by any negligence of Un Amore INC DBA Malicious Ink employees.

Hold Harmless*

The artist and Tattoo studio Un Amore INC DBA Malicious Ink have given me the full opportunity to ask any and all questions about the application of my tattoo and my questions have been answered to my total satisfaction.
I voluntarily assume all of the foregoing risks and accept sole responsibility for any infections, injury to myself, expenses of any kind, that I may incur or experience at Un Amore INC DBA Malicious Ink. I hereby release, covenant not to sue, discharge, and hold harmless Un Amore INC DBA Malicious Ink any of its officers, employees, contractors, agents, or representatives. I hereby hold harmless to not sue or pursue any claims, including all liabilities, actions, damages, costs, or expenses of any kind. I also understand and agree to that this release includes any claims based on the actions omissions or negligence of the facility, its officers, employees, contractors, agents or representatives occurs before, during or after receiving services at Un Amore INC DBA Malicious Ink.

Global Pandemic*

I agree that there is a current Global Pandemic; Covid-19, AKA 2019 novel coronavirus, 2019- nCoV, SARS-CoV-2 declared by World Health Organization. Covid-19 is extremely contagious. The virus that causes COVID-19 is believed to spread via droplets via respiratory, Aerosolized transmission via living in the air up to 3 hours, Surface transmission via several days. Spread is more likely to occur during close contact with an infected person symptomatic or asymptomatic.

Full and voluntary assumption of risk*

Un Amore INC DBA Malicious Ink has engaged and is enforcing preventive measures that follow the CDC and States guidelines to reduce the spread of Covid-19. These preventive measures however are not guaranteed as Covid-19 infection can happen to anyone anywhere. Being inside any business and partaking in services could increase your risk of infection.
I am voluntarily making assumption of risk and that I may be exposed to or infected by entering Un Amore INC DBA Malicious Ink. That may result in personal injury, illness, permanent disability and death. I understand that the risk of becoming exposed to or infected by Covid-19 at Un Amore INC DBA Malicious Ink may result from these actions, omissions, or negligence of myself and others including but not limited to Un Amore INC DBA Malicious Ink's employees, contractors and / or representatives.

Recent exposure of COVID-19*

Have you or any family member of your household tested positive, or been exposed to someone who has tested positive, for a viral infection ie: Covid-19 in the last 14 days?

Recent Symptoms of Illness*

Have you or any member of your household experienced symptoms of a viral infection? Any of the following: Fever, loss of taste or smell, dry cough, running nose, sore throat, or shortness of breath in the past 14 days?

Prolonged physical contact*

I understand that the services Un Amore INC DBA Malicious Ink offers, ie All day sessions, standard tattoo sessions, consultations, and discussions on artwork require prolonged physical contact and are administered within the otherwise recommended six feet of distance.

Photographs and IP rights*

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, this included but isn’t limited to use on social media.
IP RIGHTS belong to the artist for all custom drawings and require consent before use for personal, commercial and public use.

Video surveillance *

I consent and acknowled to the fact that the shop is equipped with video (and audio) surveillance to protect the property of the shop, the equipment, the safety of the artist, and the protection of others.

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.

Client Information

I hereby declare that I am of legal age (with valid proof of age) and am competent to sign this Agreement.

Legal Name:*

Pronoun:

Chosen name:

Address:*

Postcode:

Date of birth:*

You must be 18 or older

Phone #:*

Email:*

Signature:*

Sign above or type signature:

Emergency Contact

If something happens, your emergency contact might need to explain your medical history, allergies, or medications.

Name:

Phone #:

Photo ID*

Please take photo(s) of your government issued photo IDs and related paperwork.