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Apprentice
Let us do this part
Today's Date:
Sun May 5 2024 01:08
Practitioner:*
Please read and answer
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I hereby give consent to Zen Ink, LLC to perform a tattoo and in consideration of doing so, I hereby release and forever discharge and hold harmless Zen Ink, LLC, the Tattooist and all affiliates, Owners, Managers and Independent Contractors from any and all claims, damages or legal actions arising from or connected in any way with my tattoo, or the procedure and conduct used in my performing my tattoo, to the fullest extent allowed by the law.
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I fully understand that any Independent contractor of Zen Ink, LLC when performing a tattoo, does not act in the capacity as a medical professional. The suggestions made by any Independent Contractor or agent of Zen Ink, LLC are just suggestions. They are not to be construed as, or substituted for advice from a medical professional. I understand that the tattoo will be performed using appropriate techniques, instruments, and pigments.
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I understand that infections can occur due to lack of proper hygiene and/or pigment sensitivities. To ensure proper healing of my tattoo, I agree to follow the written and verbal aftercare instructions that will be provided, until healing is complete. I agree that any touch up work, due to my negligence, will be done at my own expense. I understand that a tattoo may take 4-8 weeks to heal properly.
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For tattoos in the areas of: Fingers, Hands, Inner Lip, Side of Foot, Bend of wrist, I understand that getting a tattoo in any of the above areas is not guaranteed to stay. It will likely fade or disappear. Touch ups (in any of the listed areas) are to be done at the expense of the client. Likely at the rate of the shop minimum each time.
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I understand there are no refunds.
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I understand that I am making a permanent change to my body, and no claims about the possibility of reversing these changes have been made or implied by Zen Ink, LLC or any of its Independent Contractors or agents.
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I agree that these waivers also pertain to and are designed to protect any and all establishments of Zen Ink and their Independent Contractors.
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I am at least 18 years old.
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Do you have a heart condition?
Details:
 
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Do you have epilepsy?
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Do you suffer from Hemophilia?
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Do you have Diabetes?
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Do you have Hepatitis/HIV or any other communicable disease?
Details:
 
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Do you have sunburn, discoloration, lumps around the tattoo area?
Details:
 
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Are you pregnant/breastfeeding?
Details:
 
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Have you eaten in the last 5 hours? It's a good idea to eat before hand to increase your blood sugar levels. If you have not, we have snacks.
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Do you suffer from any condition that makes this procedure dangerous?
Details:
 
Y
N
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Have you consumed drugs/alcohol in the last 8 hours? if so, what and how many?
Details:
 
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N
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Have you recently taken: blood thinners, antibiotics, prednisone, accutane?
Details:
 
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Are you prone to fainting?
 
Are you allergic to any of the following?
Adhesives Lavender Oil Tea tree Oil Sunflower Oil Castor Oil Coconut Oil Grapeseed Oil Calendula Arnica Peppermint Beeswax Cocoa Butter Shea Butter Mango Seed Butter Rice Bran Oil Aloe Arrowroot Powder Chamomile Extract Rosemary Extract Witch Hazel Vitamin E Oil
 
Please list any medications you take
 
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Client is responsible for checking for spelling and correct dates. I agree to check spelling and dates with my artist before the tattoo.
 
How Did You Hear About Us?
Google Facebook Instagram Referral Yelp Repeat Client Other
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I consent to Authorization for Picture of my Tattoo to be used on Social Media, Website etc
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I agree to speak softly and silence my cell phone in order to help keep a calm, spa like environment.
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COVID-19 #1*
I affirm that, to the best of my knowledge, I am not currently sick and in the last 14 days, I have not been sick, have not been in contact with anyone that is sick.
Y
N
COVID-19 #2*
I understand that getting tattooed does temporarily stress the body and the immune system, which could make me more susceptible to illness and infection. I accept this risk.
Y
N
COVID-19 #3*
I understand the Zen Ink has put additional protective measures in place in order to reduce the risk of contamination, virus, or pathogen but it is impossible to completely eliminate that risk.
Y
N
COVID-19 #4*
I agree to release and forever hold harmless Zen Ink and its agents and representatives for any and all claims, damages, or legal actions in the event I contract COVID-19 or any other illness after choosing to get tattooed.
Y
N
Covid Symptoms*
Have you experienced any symptoms (fever, cough, shortness of breath, chills, body aches, sore throat), had exposure to someone exhibiting COVID-19 symptoms or confirmed illness within the last 14 days, or have you traveled?
Details:
 
Y
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Coverups*
I understand that if I am getting a coverup tattoo that it is possible that portions of the old tattoo may show through. I understand that coverups may take multiple sessions to complete. I also understand that a coverup tattoo cannot cover existing scarring/scar tissue. Furthermore, I understand that with time and sun exposure the old tattoo may show through more than it did initially. Any touch ups on coverup tattoos, to layer in more ink, are at the customers expense.
Y
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Consent to be tattooed by an Apprentice*
I acknowledge and I am fully aware that my tattoo artist is an apprentice and still learning. I understand that apprenticeships are a form of on-the-job training where the art of the tattoo can be taught, along with techniques for avoiding blood-borne pathogens, handling needles, and studio etiquette. I understand that apprentices are still getting valuable hands-on experience and learning the craft of tattooing. I am aware that this tattoo apprentice does have valid up to date Blood Bourne Pathogen (BBP) training certificate and is registered as a Body Art Practitioner with the county Health Department. I understand the risks involved and consent to be tattooed by this tattoo apprentice.
I have read this release form and confirm that all the information I have given is correct. I understand that this is a release form and I agree to be legally bound by it.
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:*


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.