In consideration of the services of Ray’s Tattoo Inc., and all other associated persons or entities (collectively) hereafter referred to as “Ray’s” I {NAME} state that I am acting voluntarily and I fully consent to the application of a tattoo and to any actions or conduct of Ray’s reasonably necessary to the procedure. I acknowledge that I have been given the full opportunity to ask questions I might have about the tattoo procedure, to approve of the general design of the tattoo, the risks, and the care and treatment of the tattoo. I acknowledge that all my questions have been answered to my full and total satisfaction. I state and understand Ray’s will rely upon the following: 1.) I have eaten, am well rested, and am not under the influence of any medications, drugs, or alcohol of any kind of nature; 2.) I have informed the artist, {Artist}, of any skin treatment or medication taken (i.e. Accutane) within the last six (6) months, any known allergies (including latex) and any other medical or physical conditions that I might have; 3.) I am over eighteen (18) years of age and that I have shown and provided a photocopy of my photo ID to Ray’s and such photo ID is true and accurate; 4.) I do not have any communicable or other disease or condition l am not pregnant or nursing; 5.) Understand that all of the services and procedures of Ray’s are performed by an independent contractor using only single service equipment (i.e. new needles and pigments for each new client); and 6.) I will pay Ray’s ($60.00) minimum for every procedure.
As with any controlled procedure involving needles piercing the skin, (such as vaccination, shots, dentistry, donating blood, or tattooing) there are risks involved. Hepatitis B and C and HIV can be transmitted through un-sterilized or reused needles or shared ink. Certain people have or may develop latex allergies and could experience an allergic reaction to the latex gloves used during tattooing. In a small percentage of people, especially those who scar excessively, keloids can develop from a tattoo or tattoo removal. I acknowledge and agree that: 1.) this activity entails risks and I understand those risks; 2.) the risks include the possibility of injury to me; 3.) the risks I have asked about may not be complete and that there may be unknown or unanticipated risks; 4.) I assume responsibility for all risks known and unknown; 5.) I might experience an allergic reaction to the dyes, pigments, or processes used in my tattoo; and 6.) it is not reasonably possible for Ray’s to determine or ascertain whether I might experience an allergic reaction, keloid, scarring, or ink migration.
I have read, understood, and accepted the terms and conditions of this Consent and Release and acknowledge that it shall be effective and binding. I irrevocably grant to Ray’s Tattoo & Company, it’s advertisers, customers, agents, successors, and assigns, unrestricted rights to use the above mentioned sound, still, or moving images in any medium, including posting on the Internet and World Wide Web, for promotional, advertising, or other purposes without limitation. I agree that all intellectual property rights to the sound, still, or moving images, art belong to Ray’s Tattoo & Company. I voluntarily waive the right to inspect or approve such images and waive my right to any royalties, proceeds, or other benefits derived from such photographs or recordings. I understand that this release constitutes a waiver of my privacy rights under The Federal Rights and Privacy Act. This releases effective on the date of this form and will remain in effect indefinitely. I understand that there are no warranties expressed or implied of any kind or nature and Have waived any right to claim differently. I agree that tattooing is an art form and that the image may be slightly different in terms of color, clarity, size, or condition than what I expect. I waive any general damages as a result of any claim that I might have and agree that any damages, if any, against Ray’s for any reason including, but not limited to, medical complications and graphic errors shall be limited to the cost of the tattoo and there shall be no other remedy. This agreement shall be governed only by the laws of Nebraska. I made this decision freely and voluntarily and have not relied on any oral, written, or visual representation or statements of Ray’s. I agree that the individual performing the tattoo application is an independent contractor for Ray’s tattoo and they fall under this release form I am now signing. Ray’s Tattoo is not responsible for his or her actions. By signing at the end of this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19 by entering Ray’s Tattoo and that such exposure or infection may result in personal injury, illness, permanent disability and death. I understand that the risk of becoming exposed to or infected by COVID -19 may be from the actions, omissions, or negligent of myself and others, including me but not limited to, Ray’s Tattoo Staff, or other patrons.