CLEAN. CREATIVE. BOLD.
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Do you have ANY allergies? (For example: adhesives, alcohol, antibiotics, cosmetics, dyes/inks, Lanolin Oil, latex, lidocaine, metals, petroleum, shellfish, soaps.)
YES (Please describe below.)
Do you have any significant illnesses or infections (For example: auto-immunity, gonorrhea, hepatitis, herpes, HIV/AIDS, staph, syphilis, tuberculosis, etc.)
YES, I will dicsuss this with my artist.
NO, I do not have any known illness/infections.
Do you have or are you subject to any health-related conditions? (For example: bleeding condition/blood thinners, diabetes, eczema, heart condition/disease, hemophilia, high blood pressure, breastfeeding/nursing, pregnant, prone to fainting, vertigo, prone to scarring/keloiding, psoriasis, skin disease/rash, anxiety/panic/PTSD, seizures/epilepsy, etc.)
YES, I have a known health condition and will discuss this with my artist and health-care provider to ensure it is safe to proceed.
NO, I do not have any known health conditions.
INFORMED: I acknowledge that by completing and signing this form that I have been given full opportunity to ask any and all questions about obtaining my tattoo from an artist at Moscow Tattoo Company, and all my questions have been answered to my full and total satisfaction.
YES, I am fully informed.
NO, I need more information and will take responsibility for discussing this with my artist.
AGREEMENT: I specifically acknowledge that I have been advised of the facts and matters set forth below, and by my selection of items and initials, I understand and agree to the statements below. Please discontinue this form if you are not in agreement and visit with an artist regarding your concerns.
YES, I agree with the matters set forth in this document.
OVER 18 - I have truthfully represented that I am over the age of eighteen (18) years or; I am a minor and that my parent or legal guardian will accompany me and consent to tatto procedure(s)..
YES, I am over 18 years of age.
No, I am under age 18. *Please talk with your artist.
HEALTH STATUS: I have truthfully represented my health status by correctly (to the best of my knowledge) informing my artist and Moscow Tattoo Company of any health conditions, allergies, and diseases/infections. If I have not yet done so, I agree to inform my artist of any health conditions prior to beginning any procedures.
YES, I have truthfully and fully respresented my health status and any conditions.
NO, I prefer to discuss my health privately with my artist and acknowledge that it is my responsibility to share health issues with my artist.
ALLERGIC REACTION: I acknowledge and understand that it is not reasonably possible for Moscow Tattoo Company representatives and artists to determine whether I might have an allergic reaction to the dyes, pigments, processes, or products used in my tattoo.
I agree to accept the risk that such an allergic reaction is possible and do not hold my artist or Moscow Tattoo Company responsible.
SKIN CONDITIONS: I do not have a medical or skin condition that might interfere with desirable healing of my tattoo, such as acne, scarring condition (Keloidal) eczema, psoriasis, freckles, moles, sunburn in the area to be tattooed. I will inform my artist if I have any infection or rash anywhere on my body PRIOR to any procedures..
YES, I agree to inform my artist of any skin conditions or blemishes prior to any procedures.
AFTERCARE: I acknowledge that I will review written care instructions for tattoo aftercare (also available on the Moscow Tattoo Company website) and; I understand it is an absolute necessity to follow those instructions.
YES, I understand and agree that it is my responsibility to be informed of aftercare procedures prior to beginning my tattoo.
PERMANENT: I acknowledge that a tattoo is considered permanent that it can only be removed by surgical procedure, and that any removal may leave a permanent scar and disfigurement.
YES, I understand that my tattoo is permanent and consent to the application of the tattoo.
FREE WILL: I acknowledge that obtaining my tattoo is by my choice alone and; I consent to the application of the tattoo. I provide consent to the location and procedures for receiving the tattoo.
YES, obtaining a tattoo is of my own volition; I have NOT been forced or coerced into obtaining a tattoo.
DRUGS AND ALCOHOL: I acknowledge that I am not (nor will I be) under the influence of alcohol or drugs or any other intoxicating/mind-altering substance while obtaining my tattoo.
YES, I agree to not be under the influence while obtaiing my tattoo.
COPYRIGHT RELEASE: I hereby give my artist permission to copyright and publish photographic portraits or pictures of me in which I may be included in whole or in part or reproduction thereof made through any media for art, advertising, or any other lawful purpose whatsoever. I waive any right I may have to inspect and approve the finished product or the use to which it may applied.
YES, I release the artist and Moscow Tattoo Company from any copyright infringement.
LIABILITY RELEASE: I agree to release and forever discharge and hold harmless my artist and the studio in which is my tattoo is applied 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 to apply my tattoo or the processing or production of any said pictures.
YES, I release my artist and Moscow Tattoo Company and it's affiliates from any liability.
CONTRACTOR STATUS: I understand that my tattoo artist is an independent service provider and, although they lease space and equipment from Moscow Tattoo Company, my artist is not an employee of Moscow Tattoo Company.
YES, I acknowledge that my artist is an independent service provider.
TRANSLATION: If my tattoo is a symbol or something written in a language other than English, I acknowledge that the tattoo artist and Moscow Tattoo Company are not responsible for the meaning.
YES, I accept full responsibility for the meaning of my tattoo.
PROOFREADING: If my tattoo includes text/writing, I acknowledge that I am fully responsible for the correct spelling, grammar, and punctuation. I have proofread/edited the text before it is applied as a tattoo and I do not hold the artist or Moscow Tattoo Company responsible.
YES, I accept full responsibility for proofreading my tattoo content.
TATTOO VARIATION: I understand that variations in skin tones may influence the appearance of your tattoo. I acknowledge that variations in color and design exist between any tattoo as it is applied; the final product will vary as it is applied to my skin.
YES, I understand that my tattoo may vary in appearance.
TATTOO APPEARANCE: I accept responsibility for ensuring that the tattoo design is correctly drawn and oriented to my specifications; I agree to allow for artist interpretation of the image.
YES, I will ensure the accuracy of my tattoo drawing and placement.
TOUCH-UPS: I acknowledge that Moscow Tattoo Company does not guarantee tattoos on Heads, Lips, Hands, Wrists or feet. I understand that they may need more than one touch up to keep their design or color. Touch ups resulting from not following aftercare instructions or after 3 months of the tattoo are subject to fees.
YES, I understand that tattoos require maintenance and may require touch-ups (which can incur fees).
FAINTING: I agree to IMMEDIATELY notify the artist if I feel ill, queasy, lightheaded, nauseated, and/or faint before, during or after the procedure. Failure to do so releases the Artist and Moscow Tattoo Company of all responsibility.
YES, I will IMMEDIATELY notify my artist if I am not feeling well.
FEES: I understand that supply services fees may be assessed in addition to my tattoo fee. Fees will be discussed prior to beginning the tattoo and are non-negotiable once tattooing begins. I understand that fees are non-refundable. I understand that additional requests or pain relieving ointment incurs additional charge(s). Rejected/returned payments are subject to surcharges.
YES, I accept responsibility for discussing fees with my artist.
PAYMENT: I understand that payment is due in full at time of service and is non-refundable. No-Show fees, deposits, and tattoo charges are non-refundable. Payments will be made to Moscow Tattoo Company; tips are not to be discounted from the cost of your tattoo.
YES, I accept responsibility for payment to Moscow Tattoo Company.
ELECTRONIC SIGNATURE: I acknowledge that acceptance and execution of this Agreement shall be made by electronic acknowledgement, and agree that electronic acknowledgment of this Agreement with signatures and initials shall be considered the equivalent of my written signature and initials.
YES, I accept that my electrtonic signature and initials on this document/agreement is equivalent to a written signature and initials.
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