PLEASE READ CAREFULLY AND PROVIDE REQUESTED INFORMATION
Here at KeipSake Body Emporium, we strive to provide the most sterile and comfortable conditions possible. We gladly provide aftercare instructions for your new tattoo or piercing. You are responsible for the aftercare procedure.
_____ If you are a hemophiliac, diabetic, or have any illness that would effect or suppresses you immune system KeipSake Body Emporium is not liable for the healing time or condition of your tattoo or body piercing.
_____ If you have made the decision to get tattooed or pierced under the influence of drugs or alcohol or peer pressure KeipSake Body Emporium is not responsible for your regret or emotional duress in the future. I agree that any touch-up work needed due to my own negligence will be done of my own expense. I understand that if my skin color is dark, the colors will not appear as bright as it would on light skin.
_____ I agree not to hold KeipSake Body Emporium or any representatives liable for infection or injury due to improper aftercare of any body modification. You are responsible for the aftercare procedure.
_____ I hereby release KeipSake Body Emporium from all manners of liabilities, claims, actions, demands, or death, in law or in equity, which I or my heirs might have now or hereafter by reason of complying with my request for body modification, regardless of fault.
_____ I agree that I or my heirs, assigns, and legal representatives to hold KeipSake Body Emporium harmless from all other costs and expenses which might arise from my decision to have body modification done by KeipSake Body Emporium.
_____ I agree to pay for any and all damages and injuries to any and all persons and property belonging to or by operation of law caused by or resulting from my decision to have body modification work done by KeipSake Body Emporium.
_____ I agree to leave the premises of KeipSake Body Emporium or any other establishment where KeipSake Body Emporium is engaged in business, promptly upon request for any reason what-so-ever by any agent or employee of KeipSake Body Emporium.
_____ I agree that these waivers also pertain to and are designed to any and all establishments where KeipSake Body Emporium conducts business.
_____ I recognize that the suggestions and aftercare given tome by KeipSake Body Emporium employees or agents are based upon their experience in this field and current industry standards. Employees or agents of KeipSake Body Emporium are not doctors, and their suggestions, whether written or verbal, stated or implied, are not meant to be taken as medical advice. In the event of a serious medical concern I should see my physician.
I declare under penalty of perjury that the above is true, current, and correct.
EMERGENCY Contact/ Medical Information
PLEASE NOTE: The following conditions could effect and result in color loss: menstrual cycle, menopause, hormone replacement, or steroids. In addition, any medical procedures, such as surgery, preformed during the healing of today’s procedure could increase risk infection or illness.
Prior to my procedure, I will receive verbal and written information about the following and discussed it with my artist or the establishment operator: 1) a brief description of my tattoo or piercing procedure; 2) any precautions for me to take before my tattoo or piercing; 3) a description of the risks and possible consequences of body modification services; 4) instructions for care and restrictions following my body modification; and 5) restrictions against tattooing or piercing minors.
FOR MARKETING AND PROMOTIONAL PURPOSES:
I grant KeipSake Body Emporium or any members or representatives of KeipSake Body Emporium permission to use photos and/or videos of my procedure and end result for marketing and promotional purposes.
KeipSake Body Emporium must obtain a written, notarized consent statement before tattooing and/or piercing a minor. If the minor is under the age of 16, the minor MUST ALSO be accompanied by a parent or legal guardian during any tattoo and/or piercing.
All customer records must be kept for at least two (2) years.