Date:

I acknowledge by signing this agreement that I have been given the full opportunity to ask any and all questions which I might have about the obtaining of a tattoo and that all of my questions have been answered to my satisfaction. I specifically acknowledge I have been advised of the facts and matters set forth below and I agree as follows.

Referred by:

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Allergic Reaction

I DO understand that Rorschach Gallery cannot determine whether or not I will have an allergic reaction to the pigments or processes used in my tattoo, and I have agreed to accept the risk that such a reaction is possible

Medical Conditions

I DO NOT have a medical or skin condition such as but not limited to: acne, scarring(keloid), psoriasis, freckles, moles or sunburn in the area to be tattooed that may interfere with said tattoo.

Healing

I DO understand that an infection is always possible as a result of getting a new tattoo and is more likely if I DO NOT take proper care of my tattoo. I have received aftercare instructions and I DO understand that any touchups need that are caused by improper care, will come at my own expense.

Drugs/Alcohol

I am NOT under the influence of alcohol or drugs, and I am voluntarily submitting to be tattooed by the Artist without duress or coercion.

Health

I DO NOT have diabetes, epilepsy, hemophilia, a heart condition, nor do I take blood thinning medication. I DO NOT have any other condition that may interfere with the application or healing of the tattoo. I am not the recipient of an organ or bone marrow transplant or, if I am, I have taken the preventive anti-biotics. I am not pregnant or nursing. I do not have a mental impairment that may affect my judgment in getting the tattoo.

Spelling

I DO understand that neither the Artist nor the Tattoo Studio is responsible for the meaning or spelling of the symbol or text that I have provided to them.

Fading

I DO understand that variations in color/design may exist between the art I have selected and the actual tattoo. I DO understand that over time, the colors and the clarity of my tattoo will fade due to natural dispersion of pigment under the skin.

Permanent

I DO understand that a tattoo is a permanent change to my appearance and can only be removed by laser or surgical means, which can be disfiguring and/or costly and which in all likelihood will not result in the restoration of my skin.

Future Medical Procedures

I DO understand that if I have any skin treatments, laser hair removal, plastic surgery or other skin altering procedures, it may result in adverse changes to my tattoo.

Questions

I acknowledge that I have been given adequate opportunity to read and understand this document, that any and all of my questions have been answered, that it was not presented to me at the last minute, and I understand that I am signing a legal contract waiving certain rights to recover against the Artist and the Tattoo Studio.

Photography

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. (If you do not tick this provision, please advise your Artist).

Communicable Disease

I DO NOT have HIV/AIDS or any other communicable diseases. If I DO have any of the above conditions, I have informed the studio of such condition.

Coronavirus/COVID-19

I acknowledge the contagious nature of the Coronavirus/COVID-19 and the CDC and many other public health authorities still recommend practicing social distancing. I further acknowledge that Rorschach Gallery LLC has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19. I further acknowledge that Rorschach Gallery LLC can not guarantee that I will not become infected with the Coronavirus/COVID-19. I understand that the risk of becoming exposed to and/ or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, salon staff, and other salon clients and their families. I voluntarily seek services provided by Rorschach Gallery LLC and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while attending my appointment.

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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.

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