I have eaten a meal within the past 4 hours, and am well hydrated.
I have told my tattoo artist of any history of fainting, seizures, or any other conditions that may render me unconscious during the tattoo process.
I acknowledge by signing this form that I have been given full opportunity to ask any and all questions which I may have about obtaining this tattoo. All questions have been answered to my full and total satisfaction. I acknowledge that I have been advised of all the facts and matters set forth, and agree as follows.
I acknowledge that I have truthfully represented to my tattoo artist, Katie Chesna that I am over the age of 18
I acknowledge that it is not reasonably possible for the artists to know or determine whether I may have an allergic reaction to the pigments or processes used in my tattoo. I accept the risk that a reaction is possible and I do not hold the artist or business accountable for any allergic reaction that may occur.
I acknowledge that infection is always possible, particularly in the event that I do not take proper care of my tattoo. I do not hold the artist or the business liable for reaction or expenses that may occur if an infection does arise.
I acknowledge that variations in color and design may exist between any tattoos selected by me and as it ultimately applies to my body.
I acknowledge that a tattoo is considered permanent and it can only be removed by surgical procedure, and that removal may leave permanent scarring and disfigurement.
I acknowledge that I do not have a heart condition, diabetes, epilepsy, or am a hemophiliac, and that today and six months prior to today I have not or am infected with jaundice, Hepatitis, HIV, or any other contagious ailment.
I acknowledge that I am not under the influence of drugs or intoxicating liquor at the time that the tattoo is selected and administered.
I acknowledge that I am not on antibiotics or knowingly pregnant/breastfeeding.
I acknowledge that I will be following appropriate aftercare, and that not doing so may result in infection, rejection, or poor healing of my tattoo.
I acknowledge that Katie Chesna may use photographs or videos of my tattoo as promotional material or to be posted on social media.
I agree for myself, my heirs, assigns, and legal representatives to release and forever hold harmless Katie Chesna from and and all claims, damages, or legal actions arising from or connected to in any way with the tattoo or the procedures and conduct used to apply my tattoo, in any and all places that the artist conducts business.
