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CONSENT AND RELEASE AGREEMENT FOR PARAMEDICAL TATTOO TREATMENT

Please fill out the client consent form to the best of your knowledge. We reserve the right to refuse and undertake any paramedical tattoo treatment if it is deemed unsuitable or unsafe to the client. We’re delighted you have chosen our services. If requested, we will provide proof of your artist certification. You hereby release Posh Beauty Artistry, from all liability for any injury, including, without limitation, personal, bodily, or mental injury, economic loss or any damage to you resulting from your use of Posh Beauty Artistry services.

As well as liability arising from any such injury or damage resulting from your failure to disclose any pre-existing condition, limitation, or specific sensitivities, or your failure to inform your artist of any discomfort during the session. Your artist may determine that it is unsafe for you to proceed with or continue a paramedical tattoo treatment for any reason. The agreement to have a paramedical tattoo

treatment performed is entered into by:

and with reference to the facts listed on the pages of this agreement: Therefore, for there considerations, the Releasee and Releasor agree as follows:

AGREEMENT
ACKNOWLEDGEMENT OF THE RISKS OR COMPLICATIONS ASSOCIATED WITH THE PARAMEDICAL TATTOO TREATMENT.

A. The Releasor has been informed by the Releasee of the possible dangers that may occur as a result of having a paramedical tattoo treatment. The Releasor acknowledges that those dangers may occur from stretchmark removal/scar camouflage/scar lightening procedure including injury from the paramedical tattoo treatment, allergies from pigment used in the procedure(s), swelling, bruising (although rare), temporary minor bleeding, redness or pinkness, and soreness. The Releasor understands and acknowledges that the paramedical tattoo treatment may permanently alter the appearance of the Releasor’s procedure location of which may not be desirable to the Releasor.

 

B. Now, the Releasor having been fully and completely advised of all inherent risks, dangers, and complications which may arise from a paramedical tattoo treatment, voluntarily assumes all and any risks, dangers, or complications which may arise as a result of a paramedical tattoo treatment. To help minimize any risks, the Releasor will answer Yes or No the following conditions in order to describe if the Releasor has any of the following medical conditions:

IF YES, EXPLAIN

1. Keloid
3.Alcoholic
5.Under 18 Yrs
7.Using Retin A
9.Pregnant Or Nursing

If Yes,

then you cannot move forward w/ procedure at this time.

11.Autoimmune Disorders
13.Blood Disease
15.Using Glycolic Acid
17.Heart Condition
2.Diabetes
4.Epilepsy
6.Using Accutane
8.Hemophiliac
10.Active Skin Disease
12.Hepatitis
14.Chemical Peel
16.Other Tattoos
18.Allergies To ANY

(Medications Or Topical Salves Such As)

Bacitracin, Lanolin, Novocain, Metals, Neosporin, Paba, Rubber Gloves, Latex, Lidocaine, Epinephrine, Tetracaine, Benzocaine, Avocado, Coconut, frankincense, rosehip, sunflower, Other?)

19.Taking Medication
21.Blood Thinners
23.Any Recent Laser
25.Currently under doctors care?
20.Any Other Diseases
22.Using Tanning Bed Or Products
24.Planning Cosmetic Surgery?
26. Planning any Vacation

A. The Releasor agrees to waive or to take a 6-week patch test prior to the paramedical tattoo treatment.__________Initial to waive  patch test 

B. The Releasor agrees to accept full responsibility of each and every procedure that the Releasor will have performed by the Releasee which is to include but not limited to the Stretch mark, scar camouflage, breast re-pigmentation, and various paramedical tattoo treatments.

C. The Releasor agrees that in the event of a controversy between the Releasor and the Releasee involving a claim in tort, the parties shall resolve their dispute through small claims court.

D. The Releasor agrees that in the event that the Releasor prevails in a judgement against the Releasee, the Releasor agrees that the Releasor will not be entitled to a settlement that exceeds the amount paid for the work accomplished by the Releasee. 

E. The Releasor acknowledges receipt of pre-procedure information and post-op care instructions, has read them, has been verbally told them, understands them, and agrees to adhere to them in order to help prevent secondary infection.

CONSENT TO PARAMEDICAL TATTOO TREATMENT

The Releasor fully and voluntarily consents to have the releasee perform the PARAMEDICAL TATTOO TREATMENT(s) and is fully aware and informed of all and any inherent risks, dangers, and complications that may occur as a result of the procedure(s) as described in this agreement. The Releasee has reviewed the medical history of the Releasor and all questions of the Releasor have been satisfactorily answered by the Releasee.

2.RELEASE OF ALL CLAIMS

a. For the Releasee to perform any paramedical tattoo treatment on the Releasor for which the Releasee is volunteering to have performed after having been fully informed of all dangers and risks involved as described in this agreement including but not limited to

swelling, allergy to pigment, pain, infection, redness, soreness, injury, and itching. 

voluntarily request that the Releasee performs such procedure(s) and I, for myself,  my respective heirs, assigns, administrators, personal representatives, and next of kin, hereby will forever release and hold harmless the Releasee, Posh Beauty Artistry LLC, and all Management, their affiliates, officers, members, agents, employees, other participants, and sponsoring agencies from and against any and all claims, damages, or liabilities that may result from the paramedical tattoo treatment(s) as described in this agreement including costs of medical care that may arise from the procedure including post-op care. The Releasor acknowledges that no other claims or guarantees have been made by the Releasee other than is expressly written in the agreement. In witness where of both parties, the Releasor and the Releasee enter into this agreement by their signatures below on the date opposite their names

 

By signing below, I agree to any and All statement & conditions stated above, Any information provided by Releasor is true to the best of his/her knowledge.

PHOTOGRAPHER’S/VIDEO RELEASE

For a consideration mutually agreed upon, and received by me for posing for photographs and/or video(s)hereto, I the undersigned to hereby assign to you the copyright and/or the right to copyright such photography and the right of reproduction thereof, either wholly or in part, an unrestricted use thereof in whatever manner of you or your license sees or assignees may, in your or their absolute discretion, think fit for all or any advertising, medical teachings, or other purposes whatsoever including the right of necessary retouching and tinting or workup for reproduction purposes.

PARENT OR LEGAL GUARDIAN

 

If you are the parent or legal guardian of the above named Releasor, then please complete the following:

 

 

 

 

 

represent that I am the parent or legal guardian of the above named Releasor, have read the full agreement including the above Recitals and give my full permission to execute this agreement on the Releasor’s (minor’s) behalf. 

Thanks for submitting!

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