Consent WaiverBefore beginning this form, please take a clear, flat photo of your state issued ID Please download and review our aftercare instructions. If you have any questions, please ask your artist or call the shop for help. Name (If your preferred name differs from your driver's license, please use preferred name here) * First Name Last Name Preferred Pronouns (optional) Email * Checkbox * May we email you shop updates? Yes No Phone Number * Street Address * City * State * Zip/Postal Code * Country * Artist * Who is tattooing you today? Amber Andre Dane Getty Ivy Mark Raymond Thomas Guest Artist Description Of Tattoo * What are you getting tattooed today, and where on your body will it be placed? Emergency Contact Name and Phone Number Medical History Please answer the following questions Hepitatis B * Yes No Hepatitis C * Yes No HIV/AIDS * Yes No Diabetes * Yes No Hemophilia or any other blood disease/disorder * Yes No Skin diseases or skin lesions * Yes No Sensitivities to soaps, disinfectants, etc. * Yes No Allergies to pigments, dyes, latex, etc. * Yes No If you answered yes: What allergies should we be aware of? Tuberculosis * Yes No Autoimmune disorders * Yes No Epilepsy, seizures, fainting, or narcolepsy * Yes No Keloid scarring * Yes No Heart murmur or heart disease/conditions * Yes No Are you currently taking blood thinners/anticoagulants * Yes No Are you under the influence of drugs or alcohol * Yes No Are there any other conditions we should be aware of? * Yes No Are you pregnant or breast feeding? * Yes No Have you been sick or exposed to someone who is sick within the last 14 days? * Yes No WAIVER, RELEASE, AND CONSENT FOR TATTOOING PROCEDURE * In consideration of receiving a tattoo from Hot Love Tattoo including its artists, associates, apprentices, agents, or any employees, I agree to the following: That I have been fully informed of the inherent risks associated with getting a tattoo. Therefore, I fully understand that these risks, known and unknown, can lead to injury including but not limited to: infection, scarring, difficulties in the detection of melanoma and allergic reactions to tattoo pigment, latex gloves and/or soap. Having been informed of the potential risks associated with getting a tattoo I wish to proceed with the tattoo procedure and application and freely accept and expressly assume any and all risks that may arise from tattooing. I waive and release to the fullest extent permitted by law Hot Love Tattoo and it’s artists from all liability whatsoever, including but not limited to, any and all claims or causes of action that I, my estate, heirs, executors or assigns may have for personal injury or otherwise, including any direct and/or consequential damages, which result or arise from the procedure and application of my tattoo, whether caused by the negligence or fault of either Hot Love Tattoo, or otherwise. I have been given the full opportunity to ask any question about the procedure and application of my tattoo and all of my questions, if any, have been answered to my total satisfaction. I have been given instructions on the care of my tattoo while it's healing. I understand and will follow them. I acknowledge that it is possible that the tattoo can become infected, particularly if I do not follow the instructions given to me. If any touch-up work to the tattoo is needed due to my own negligence, I agree that the work will be done at my own expense. I am not under the influence of alcohol or drugs, and I am voluntarily submitting to be tattooed without duress or coercion. I do not suffer from diabetes, epilepsy, hemophilia, heart condition(s), nor do I take blood thinning medication. I do not have any other medical or skin condition that may interfere with the procedure, 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 prescribed preventative regimen of antibiotics that is required by my doctor in advance of any invasive procedure such as tattooing or piercing. I am not pregnant or nursing. I do not have a mental impairment that may affect my judgement in getting the tattoo. Hot Love Tattoo and it’s artists are not responsible for the meaning or spelling of the symbol or text that I have provided to them or chosen from the flash (design) sheets. Variations in color and design may exist between the tattoo art I have selected and the actual tattoo when it is applied to my body. I also understand that over time, the colors and the clarity of my tattoo will fade due to unprotected exposure to the sun and the naturally occurring dispersion of pigment under the skin. 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 to its exact appearance before being tattooed. I agree to reimburse Hot Love Tattoo for any attorneys' fees and costs incurred in any legal action I bring against Hot Love Tattoo and in which either my tattoo artist or Hot Love Tattoo is the prevailing party. I agree that the courts located in Leon county within the State of Florida shall have jurisdiction and venue over me and shall have exclusive jurisdiction for the purposes of litigating any dispute arising out of or related to this agreement. I acknowledge that I have been given adequate opportunity to read and understand this document, that it was not presented to me at the last minute, and grasp that I am signing a legal contract waiving certain rights to recover damages against Hot Love Tattoo and it’s artists. 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. I hereby declare that I am of legal age (and have provided valid proof of age and identification) and am competent to sign this Agreement. I HAVE READ THE AGREEMENT, I UNDERSTAND IT, AND I AGREE TO BE BOUND BY IT. I AGREE Digital Signature * By typing your name below you are agreeing that you have accurately answered your medical history and have provided Hot Love Tattoo with all of your current information Thank you!