PLEASE NOTE:

This form is for website viewing purposes only! This form will not be accepted if brought in to your appointment. An official form will be provided to you on the day of your appointment that you will need to fill out before receiving any services from House of Judah Tattoo LLC.

• I, (First and Last Name) 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, disfigurement, difficulties in the detection of melanoma and allergic reactions to tattoo pigment, latex gloves and/or soap, or illness including permanent disability or death. 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 any person of House of Judah Tattoo LLC 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 the House of Judah Tattoo LLC, or otherwise.

• House of Judah Tattoo LLC has given me 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.

• House of Judah Tattoo LLC has given me 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. One free touch up is available during the duration of the first year starting from the date of my original appointment.

• I do NOT suffer from hepatitis, diabetes, epilepsy, hemophilia, high blood pressure, heart condition(s), HIV/ AIDS, nor do I take blood thinning medication. I am NOT prone to fainting or vertigo. (Please let your artist know if these or any other conditions apply).

• I do NOT have any other medical or skin condition that may interfere with the procedure, application or healing of the tattoo including, but not limited to: MRSA, Psoriasis / Eczema, or Sunburn (Please let your artist know if these or any other conditions apply).

• I am NOT allergic to latex, soap, metals, or tattoo pigments.

• Do you require an “EPIPEN?”

  • Yes

  • No

  If “Yes,” what do you use it for? ___________________________.

• Do you require an Inhaler or an Emergency Inhaler?

  • Yes

  • No

  If “Yes,” what do you use it for? ___________________________.

• 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 judgment in getting a tattoo.

• I am NOT under the influence of any substances that would affect my judgment in getting a tattoo. Substances including, but not limited to: alcohol and other drugs. I am voluntarily submitting to be tattooed by House of Judah Tattoo LLC without duress or coercion.

• I have NOT consumed any anticoagulants (blood thinning medication) within the last 24 hours (such as Aspirin or Ibuprofen). 

• I HAVE eaten within 2 hours of my scheduled appointment with House of Judah Tattoo LLC.

• I CERTIFY that I am 18 years of age or older.

• House of Judah Tattoo LLC is 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 release the right to any photographs taken of me and the tattoo and give consent in advance to their reproduction in print or electronic form. (For assurance, if you do not initial this provision, please inform House of Judah Tattoo LLC NOT to take any pictures of you and your completed tattoo). 

• I agree that House of Judah Tattoo LLC has a NO REFUND policy on tattoos, piercing and/or retail sales and I will not ask for a refund for any reason whatsoever.

• I agree to reimburse House of Judah Tattoo LLC for any attorneys' fees and costs incurred in any legal action I bring against the House of Judah Tattoo LLC and in which either the Artist of the Tattoo Studio is the prevailing party. I agree that the courts located in the County of Marion within the State of Oregon 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 and that it was not presented to me at the last minute. I understand that I am signing a legal contract waiving certain rights to recover damages against House of Judah Tattoo LLC.

• 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.