TATTOO AND PIERCING

Consent Form

In consideration of receiving a tattoo from Culture Club, including their artists, associates, apprentices, agents, or any employees (hereinafter referred to as the tattoo studio). I agree to the following:

– I have been fully understand that these risks, know and unknow, can lead to injury including but not limited to: infections, scarring, allergic reactions to tattoo pigment, gloves or soap . having been informed of the potential risks associated with getting a tattoo. I wish to proceed with the tattoo procedure and application.
– I am least at 18 years old.
– I do not have a heart condition.
– I do not have epilepsy.
– I have not had hepatitis within the last twelve months.
– I am not a hemophiliac (bleeder).
– I am not under the influence of any drugs of alcohol.
– I do not have any physical, mental or medical impairments or disability which might affect my well being as a direct result of my decision to have any tattoo related work or piercing done at this time.
– I am not pregnant or nursing.
– I freely accept and expressly assume any and all risk that may arise from tattooing.
– I agree to fallow all instructions pertaining to the care of my tattoo or piercing while it is healing.
– I agree any touch-up work needed, due to my own negligence, will be done at my own expense.
– I understand that if my skin tone is of a darker complexion, the colors will not appear as bright as they would with a lighter skin complexion.
– I also understand that over time, the colors and clarity of my tattoo will fade due to unprotected exposure to the sun and the naturally occurring dispersion of pigments under the skin.
– The tattoo studio is not responsible for the meaning or spelling of symbols or text that have been provided to them or from any chosen on the flash (design) sheets.
– I agree that Culture Club has a NO REFUND policy on tattoos, piercing and/or retail sales.
– I waive any and all rights and consent that I will not get a refund for any deposit(s) and/or total payment(s) made.
– I release the right to any photographs taken of me and the tattoo and give consent in advance to their reproduction in print and/or electronic form.
– Being of sound mind and body, I hereby release Culture Club and its affiliates from any and all liability.
– I accept all responsibility for myself for all consequences that might occur as a result from my own decision to have any tattoo-related work or piercing done.
– I agree never to pursue any legal action in connection with any and all damages, claims, demands, rights, and causes of action of whatever kind of nature, based upon injures or property damage to, or death of myself or any persons arising from my decision to have tattoo-related work or piercing done at this time, whether or not caused by any negligence by Culture Club or its affiliates.
– I agree myself, my heirs, assigns, and legal representatives to hold Culture Club harmless from all damages, action, causes of action, claims judgments, cost of litigation, attorney’s fees, and all other costs and expenses which might arise from my decision to have any tattoo-related work or piercing done by Culture Club.
– I agree to pay for any and all damages and injuries to any and all persons property belonging to Culture Club, or any other person to whom Culture Club may become liable contractually or by operation of law, caused by, or resulting from my decision to have any tattoo-related work or piercing done by Culture Club and its affiliates.
– I agree to leave the premises of Culture Club or any other establishment where the Culture Club is engaged in business upon request for any reason whatsoever by an agent or employee of Culture Club.
– I agree that these waivers also pertain to and are designed to protect any and all establishment where Culture Club conducts business.
I represent and warrant to Culture Club that the fallowing information is true.

CITY AND STATE WHERE YOU ARE LOCATED:
FORM OF IDENTIFICATION
VALID ID OR DRIVERS LICENSE
- I AM OVER THE AGE OF 18 - I DECLARE THAT THE INFO I`VE PROVIDED IS ACCURATE & COMPLETE