Consent Form Tattoo Consent I am above the age of 18 years old * Yes, I’m over 18 yrs old I’m under 18 and have a parent / guardian with me for consent Name of parent / guardian (if underage) (Name of Parent or Guardian) Tattoo or piercing description * Example: Clown Tattoo on Knee Service * Tattoo Piercing Both Tattoo and Piercing Age and Health I acknowledge the following: I am not under the influence of drugs or alcohol. I am not pregnant, in good health and fully aware of my decision to get a tattoo or piercing at the agreed time. I am 18 years old or older or under the age of 18, I have parental or a legal guardian present and have proof in the form of legal ID, birth certificate and/or legal guardianship documents. It is not always possible to determine if I might have an allergic reaction to the tattoo or piercing process. I will inform the artist of any known allergies to Bacitracin, Neosporin or Iodine or any other allergy related to the process. I will inform the artist of any illness such as hemophilia, eighths (HIV), hepatitis C, diabetes or any related illness that could affect the process. Art Design and Placement I give consent to any POR VIDA representative to perform either tattoo or piercing related work including the design and placement. Any extensive drawing from the artist must be compensated with an automatic $20.00 deposit to show commitment to the service. At the discretion of the artists, POR VIDA will honor touch-up work not to exceed one month after initial application of the tattoo for free. Any touch up work requires an appointment. If I decide not to get a tattoo or piercing after the artist has opened materials, I agree to pay the supply fee which is $20.00 or more. Review of Risk If I do not take proper care of my tattoo or piercing, infection is always possible. I shall not hold POR VIDA or POR VIDA artist or representative liable for any problems our expenses that may occur if an infection or any other reaction does develop. . I have been giving full opportunity to ask questions which I may have about obtaining a tattoo or piercing and my questions have been answered to my complete and total satisfaction. I assume all risk of loss or injury of any kind that may be associated with tattoo or piercing. Tattoo or piercings of the body should be limited to the skin area as piercing of the cartilage can result in a possibility of redness, slower healing, and or infection. I hold only myself responsible for any injuries that may result if I have my body pierced or tattooed in this or any other such manner. Pick the Artist * First Available for Walk-In Jay (Piercer) Bael Oven Lil Aleh Helm Julio Mike Nore Kevin Urban Sneez Myra Ivan Goof Nacho Josh If you do not know artist name, feel free to ask Front Counter Consent and disclaimer Por Vida reserves the right to refuse service to anyone. I agree not to hold any Por Vida employee or representative responsible or liable for any reason. I accept the risk inherent to tattoo or piercing and I don’t hold Por Vida responsible or libel in any way it’s such a risk occurs. I hereby for myself my heirs, assignees, legal representatives release Por Vida forever and hold harmless for all claims, damages, loss or legal actions arising from or connected in any way with the tattoo artist or body pierce whether rising in negligence or otherwise. I am fully aware of all risk that may occur during or after my tattoo or piercing. Because tattoo inks, dyes and inks have not been approved by at the FDA and health consequences of using these products are unknown. I voluntarily undergo and consent to the tattoo or piercing process. I have read, understood and agree to all the above. Regards to COVID-19 We must maintain contact tracing records for no less than 21 calendar days by recording the date and time, names, phone numbers and email addresses of all customers who dine on premises (indoor and outdoor). This information must be made available upon the request of the NM Department of Health. If you have been directly exposed to someone under investigation for, or with a confirmed case of, COVID-19 in the past 14 days, please remain at home and self-isolate. If you have experienced any COVID-19 related symptoms such as fever, cough, shortness of breath, loss of taste or smell, etc., please remain at home and self-isolate. Visit the New Mexico Department of Health website for a full list of symptoms and additional requirements for contact. FIRST NAME * Printing my name serves as my signature and acceptance of terms. LAST NAME * Printing my name serves as my signature and acceptance of terms. Cell Number * Email Address * TYPE IN YOUR DRIVERS LICENSE OR ID NUMBER HERE. * PLEASE SHOW ID TO FRONT DESK! reCAPTCHA If you are human, leave this field blank. Δ
