Cosmetic Tattoo Release Form

Basic Info:

Today's Date:

Mon Jun 22 2026 07:35:29

Artist:*

How did you hear about us?:*

Please read & answer:

Acknowledgement*

I acknowledge by signing this agreement that I have been given the full opportunity to ask all questions which I might have about obtaining a tattoo and that all of my questions have been answered to my total satisfaction. I expressly acknowledge I have been advised of the facts and matters set forth below, and I agree as follows:

Booking & Pricing*

I understand and agree to the booking & pricing information listed below.

Booking Fee/Deposit: If you paid a booking fee/deposit when booking your appointment, it will be applied towards your final bill.

Pricing: I have been given an estimate of my final price by the tattoo artist and agree to pay the final amount they calculate at the end of the tattoo.

Medical History*

If I have any condition that might affect the healing of this tattoo, I will advise my tattooer. I am not pregnant or nursing. I am not under the influence of alcohol or drugs.

I do not have medical or skin conditions such as but not limited to: acne, scarring (Keloid), eczema, psoriasis, freckles, moles, or sunburn in the area to be tattooed that may interfere with said tattoo. I will advise my tattooer if I have an infection or rash anywhere on my body.

I do not have diabetes, epilepsy, hemophilia, or a heart condition, nor take blood thinning medication. I do not have any other condition that may interfere with the application or healing of the tattoo. I am not the recipient of an organ or bone marrow transplant; if I am, I have taken preventive antibiotics.

I am not pregnant or nursing.

I do not have a mental impairment that may affect my judgment in getting the tattoo.

Future Treatments*

I understand that if I have any skin treatments, laser hair removal, plastic surgery or other skin altering procedures, it may result in adverse changes to my permanent cosmetics. I acknowledge some of these potential adverse changes may not be correctable.

Allergy*

I acknowledge that the representatives and employees of this tattoo shop can't determine whether I might have an allergic reaction to the pigments or processes used in my tattoo, and I accept the risk that such a reaction is possible.

Infection*

I acknowledge that infection is always possible due to obtaining a tattoo, mainly if I do not take proper care of my tattoo. I have received aftercare instructions and agree to follow them while my tattoo is healing. I agree that any touch-up work needed due to my negligence will incur an additional fee.

Aftercare*

I have received pre- and post procedure instructions and I will strictly adhere to such instructions. I understand that my failure to do so may jeopardize my chances for a successful procedure. If I am on any medication for depression or any other mood altering prescription, I will advise my technician. If I have ever had cold sores, I will consult with and strictly follow my doctor's instructions before contemplating any permanent cosmetic procedure around my lips.

Healing*

The Artist and the Tattoo Studio have given me instructions on caring for my tattoo while it's healing, and I understand them and will follow them.

Risks*

I have been informed of the nature of the tattoo and/or permanent skin pigmentation procedure, including the inherent known and unknown risks, possible complications, and consequences associated with these procedures. I fully understand that these risks may lead to injury, including but not limited to infection, scarring, difficulties in detecting melanoma, allergic reactions to tattoo pigment, latex gloves, and soap, inconsistent color, and the spreading, fanning, or fading of pigments. I understand that the actual color of the pigment may be modified slightly due to the tone and color of my skin. I further understand that tattooing and permanent skin pigmentation are not exact sciences, but artistic processes. Having been informed of the potential risks, complications, and consequences, I still wish to proceed with the tattoo and/or permanent skin pigmentation procedure(s), and I freely accept and expressly assume all risks, as well as the permanence of the procedure(s).

Design*

Neither the Artist nor the Tattoo Studio is responsible for the meaning or spelling of the symbol or text I provided or chose from the flash (design) sheets.

I understand that variations in color and design may exist between any tattoo I selected and the color and design applied to my body.

I also understand that over time, my tattoo's colors and clarity will fade due to the natural dispersion of pigment under the skin.

I understand that if I have any significant weight gain or loss, skin treatments, laser hair removal, plastic surgery, or other skin-altering procedures may result in adverse changes to my tattoo.

Permanence*

I acknowledge that a tattoo is a permanent change to my appearance and that no representations have been made regarding the ability to later change or remove my tattoo. A tattoo is a permanent change to my appearance. It can only be removed by laser or surgical means, which can be disfiguring and costly and will, in all likelihood, not restore my skin. To my knowledge, I do not have a physical, mental, or medical impairment or disability which might affect my well-being as a direct or indirect result of my decision to have a tattoo.

Contact Lenses*

Do you wear contact lenses? These must be removed before any tattooing occurs in the eye area.

Cold Sores*

Have you ever had a cold sore in the area to be tattooed? If yes, you must contact your physician for a prescription of ZOVIRAX capsules, a medication which prevents cold sores.

I have read the above information regarding ZOVIRAX and understand its use is mandatory if I desire lipline or full lip color procedures, or any tattoo in an area where I have had a cold sore in the past.

Physicians Care*

Details:

Pregnant or Nursing*

Are you pregnant or nursing?

Antibiotics*

Details:

Medical History*

Details:

Medications*

Details:

Right to Consent*

I acknowledge I am over eighteen and have truthfully represented to my tattooer that obtaining a tattoo is my choice alone. I consent to applying the tattoo and to any actions or conduct of the representatives and employees of the tattoo shop reasonably necessary to perform the tattoo procedure.

I desire to receive the indicated permanent cosmetic procedure. The general nature of cosmetic tattooing as well as the specific procedure to be performed has been explained to me.

I am not under the influence of alcohol or drugs and am voluntarily submitting to be tattooed by the Artist without duress or coercion.

Indemnification*

I agree to indemnify and defend Ro Bataille, LLC, Iron Cherry, LLC, Cherry Bomb Studio, my service provider, as well as any representatives, employees, contractors, and agents against all claims, causes of action, damages, judgments, costs, or expenses, including attorney fees and other litigation costs, which me in any way arise for my use of or presence upon the facilities of Cherry Bomb Studio located at 231 Eldridge Street.

I agree to waive and release to the fullest extent permitted by law each of the Artist and the Studio from all liability whatsoever for any claims or causes of action that I, my estate, heirs, executors, or assigns may have for personal injury or otherwise, including any direct and consequential damages, which result or arise from my tattoo, whether caused by the negligence or fault of either the Artist or the Tattoo Studio, or otherwise.

I agree to reimburse each of the Artist and the Tattoo Studio for any attorneys' fees and costs incurred in any legal action I bring against either the Artist or the Tattoo Studio and in which either the Artist or the Tattoo Studio is the prevailing party. I agree that the courts of New York shall have personal jurisdiction and venue over me and shall have exclusive jurisdiction for litigating any dispute arising out of or related to this agreement.

Unenforceability*

I understand Release of Liability or unenforceability of any provision of this Release of Liability shall not affect any other condition in this Release of Liability or any other applications of such provision, and such unenforceable provision shall be deemed not to be part of this Release of Liability.

Mediation*

I agree that the parties will attempt to resolve any dispute arising from or relating to this Release of Liability through friendly negotiations. If the matter is not resolved, the parties agree to use mediation.

Payments*

I have read and agree with the pricing and policies.

Payment will be made to the Business via cash or any other payment method determined by the Business.

I understand that my final price may differ from what is reflected in this appointment booking due to either error while booking or additional, less, or other services provided.

After completing my service, I agree to pay the remainder of the total final price calculated and requested. If I have questions about pricing, I will ask for that information before my appointment begins.

Unless previous arrangements are made, if I refuse to pay the requested amount at the time of service, my card on file may be charged that amount, and Ro Bataille, LLC will provide me with an itemized receipt of the charges.

No Refunds*

The Customer will be assumed to have accepted the Goods unconditionally. The deposit and final charge are non-refundable.

No refunds will be provided for the work completed or services performed under this Contract.

Authority*

Each party has the authority to enter this Contract and perform all its obligations under it.

Signatures*

This Contract may be signed electronically or in hard copy. Electronic signatures count as original for all purposes.

Changes*

The Client and the Business must agree to any changes to this Contract in writing.

Acknowledgement*

I have read this document and understand its contents. I acknowledge that the information I gave in this form is accurate and complete. I understand that I voluntarily surrender certain rights by signing this Release of Liability. By signing below, I confirm that I understand and agree to all terms and statements in this form.

I certify that I am a competent adult of at least 18 years of age. This consent form is freely and voluntarily executed and shall be binding upon my spouse, relatives, legal representatives, heirs, administrators, successors, and assigns.

I have read and understand this agreement. The nature and purpose of the treatment have been explained to me. All my questions have been answered to my satisfaction, and I consent to the terms of this agreement.

By signing your name as a signature below, you agree to the terms and provisions of this agreement.

Photo Release*

I release all rights to any photographs taken of me and the tattoo and give consent in advance to their reproduction in print or electronic form or in any new media. I permit to use of my photos for marketing. My pictures may appear in print or online or new media. (If you choose NO this provision, please advise your Artist).

Procedure Photos*

I understand that the taking of before and after photographs of the said procedure(s) are a condition of such procedure(s). I certify I have read and initialed the above paragraphs and have had explained to my understanding this consent and procedure permit. I accept full responsibility for the decision to have this cosmetic tattoo work done.

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.

Personal Info

I hereby declare that I am of legal age (with valid proof of age) and am competent to sign this Agreement.

Name:*

Address:*

Date of birth:*

Phone #:*

Email:*

Signature:*

Photo ID(s)*

Please take a picture of your government issued photo ID