info@embedded.ink Tattoo Consent Form TO INDUCE KEN ENGLISH & 2027254 ALBERTA LTD, OPERATING AS EMBEDDED INK to tattoo my: * and in consideration of it’s doing so, I hereby release KEN ENGLISH & 2027254 ALBERTA LTD, OPERATING AS EMBEDDED INK and their agents, from all manner of liabilities, claims, actions and demands, in law or in equity, which I or my heirs have or might have now or hereafter by reason of complying with my request to be tattooed. I agree to reimburse each Of the Artists and the Tattoo Studio for any legal fees and costs incurred in any legal action. I agree that the courts of Alberta in Edmonton shall have personal jurisdiction and venue over me and shall have exclusive jurisdiction for the purpose of litigating any dispute arising out of or related to this agreement. Please read and check each box to confirm that you understand the following: * I FULLY UNDERSTAND that any agent of KEN ENGLISH & 2027254 ALBERTA LTD, OPERATING AS EMBEDDED INK are just suggestions. They are not to be construed or substituted for advice from a medical professional. I UNDERSTAND I WILL BE TATTOOED using appropriate instruments and techniques. To ensure proper healing of my tattoo, I agree to follow the suggestions outlined in the written tattoo-specific aftercare instructions provided to me until healing is complete. I understand that a tattoo usually takes two (2) weeks or longer to heal. I ACKNOWLEDGE that I have been given the full opportunity to ask any and all questions which I may have about obtaining a tattoo and that all my questions have been answered to my satisfaction. I ACKNOWLEDGE that I have been notified of the possible risks and dangers associated with receiving a tattoo. These risks/dangers include, but are not limited to, the following possibilities: discomfort or pain, scarring, bleeding, swelling, allergic reaction, rejection of ink, risk of infection (particularly in the event I do not follow the aftercare instructions that I have been provided). Neither the Artist nor KEN ENGLISH & 2027254 ALBERTA LTD, OPERATING AS EMBEDDED INK are responsible for the meaning of a symbol or spelling of any words that is provided to them. I HAVE RECEIVED A COPY OF THE WRITTEN TATTOO-SPECIFIC AFTERCARE INSTRUCTIONS, which I have read and fully understand. I hereby assume full responsibility for aftercare and cleanliness. I understand that by having this tattoo performed that I am making a permanent change to my body and no claims have been made regarding the ability to undo the changes made. ALL PHOTOGRAPHS / VIDEOS I ALLOW TO BE TAKEN may be used for advertisement, blog posts, social media, educational material and media release for KEN ENGLISH & 2027254 ALBERTA LTD, OPERATING AS EMBEDDED INK. I may decline having my picture taken. Have you eaten within the last 4 hours? No Yes Have you had any alcoholic beverages in the last 8 hours? No Yes Are you prone to fainting? No Yes Are you prone to heavy bleeding? No Yes Do you have to take antibiotics before seeing the dentist? No Yes Have you taken aspirin, ibuprofen, or blood thinners within the last 24 hours? No Yes Do you have any allergies? No Yes Please list any allergies you have: Are you pregnant or breast-feeding? No Yes Do you have other conditions which might affect the healing of this tattoo? No Yes Have you had symptoms or contact with anyone with COVID-19 in the past 2 weeks? No Yes Do you have other conditions which might affect the healing of this tattoo? No Yes Would you like to join our email list for promotions and announcements? No Yes How did you hear about KEN ENGLISH & 2027254 ALBERTA LTD, OPERATING AS EMBEDDED INK? Please upload a Picture of your Government Issued Photo ID * Click here to upload Choose Photo Maximum file size: 516MB Date of Birth * Name * Name First First Last Last Preferred Name Pronouns Address * City * Province * Postal Code * Phone * Email * Today's Date * Agreement * By checking this box you confirm that all provided information is correct and you agree to all terms and conditions. Staff use only: Needle Lot Numbers Drop a file here or click to upload Choose File Maximum file size: 516MB If you are human, leave this field blank. Submit
