QR Code Sign In Artist's name: Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Date of Birth MM slash DD slash YYYY List any health conditions (Hepatitis, HIV, Diabetes, BloodThinners, allergies, etc) that your Artist should be aware of prior to your procedure:Driver's License# Description: Age: Check all that apply: Junkyard Ink, LLC and any artist conducting business within has the right to refuse service at any time for any reason. A valid photo ID must be presented to have services rendered (state-issued driver’s license or identification card, passport, or military ID are acceptable.) Photo Copies of any ID or expired IDs will not be permitted. Anyone under the age of 18 is considered a minor and must have a notarized affidavit provided by artist) from a custodial parent prior to any consultation. One custodial parent must be present during all tattoo sessions. If you are sick, intoxicated, under the influence of drugs, pregnant or being unprofessional and or causing a disturbance of any kind, services will not be rendered at that time and you will be asked to vacate the premises. It is the sole responsibility of you, the client, to keep track of all appointments and scheduled times of service. Children are permitted in the shop but must be supervised at all times. Children also must stay in the lobby and are not allowed in any tattoo areas so as they do not cause a disturbance to other clients or the artists. All deposits are NON-REFUNDABLE, at no time will a refund of any kind be given for any reason and all transactions are final. Appointments will not be scheduled until a deposit is paid (cash or credit) and they will be credited toward the final price of your tattoo. If you require several sessions for your tattoo the deposit will be credited to your final session. Artwork created for your tattoo is the sole property of the artist and will not be given, emailed or copied for the client. Alterations to designs without sufficient notice may result in rescheduling of appointment and loss of deposit due to lack of proper notification. A minimum of 24 hours notice of cancellations must be given to the artist to retain your deposit for reschedule. Any other circumstances, less than 24 hours notice, complete cancellation without rescheduling, not showing for your appointment, etc. will result in forfeiture of your deposit. I have been fully informed of the inherent risks associated with getting a tattoo. I fully understand that these risks, known and unknown, can lead to injury, including but not limited to infection, scarring, difficulties in detecting melanoma arid allergic reactions to tattoo pigment, latex gloves, any ointments/lotions and or soap. Having been informed of the potential risks associated with getting a tattoo, I still wish to proceed with the tattoo application and I freely accept and expressly assume all risks that may arise from tattooing. I waived and release to the fullest extent permitted by law the Artist from all liability whatsoever, for any and all claims or cause of action that I, my estate, heirs, executors or assigns may have for personal injury or otherwise, including any direct and/or consequential damages, which result or arise from the application of my tattoo, whether cause by the negligence or fault of the Artist or otherwise. The Artist has given me the full opportunity to ask any and all questions about the application of my tattoo and all my questions have been answered to my total satisfaction. I acknowledge that I have been given adequate opportunity to read and understand this document, and I understand that 1 am signing a legal contract waving certain rights to recover against the Artist The Artist has given me instructions on the care of my tattoo while it is healing and I understand them and I will follow them. I acknowledge that it is possible that the tattoo can become infected, particularly if I do not follow the instructions given to me, Some touch- up work is complimentary, however if any touch-up work to the tattoo is needed due to my own negligence, I agree that the work will be done at my own expense I am not under the influence of alcohol or drugs and I am voluntarily submitting to be tattooed by the Artist without duress or coercion. The Artist is not responsible for the meaning or spelling of the symbol or text that I have provided them personally or chosen elsewhere. is the correct spelling/meaning of text I have chosen. Variations in color and design may exist between the tattoo art I have selected and the actual tattoo when it is applied to my body. I also understand that over time, the colors and the clarity of my tattoo may fade due to unprotected exposure to the sun and the naturally occurring dispersion of the pigment under the skin. A tattoo is a permanent change to my appearance and can only be removed by labor or surgical means, which can be disfiguring and or costly and which in all likelihood will not result in the restoration of my skin to its exact appearance before being tattooed. Variations in color and design may exist between the tattoo art I have selected and the actual tattoo when it is applied to my body. I also understand that over time, the colors and the clarity of my tattoo may fade due to unprotected exposure to the sun and the naturally occurring dispersion of the pigment under the skin. A tattoo is a permanent change to my appearance and can only be removed by labor or surgical means, which can be disfiguring and or costly and which in all likelihood will not result in the restoration of my skin to its exact appearance before being tattooed. If this is a cover-up tattoo or the new artwork requested of your Artist will incorporate or include any previously done tattoo, you may experience some, if not all, of the following bleeding through immediately or at a later date and/or an allergic reaction that may disfigure the new or older work. This list is non comprehensive and other physical imperfections, infections or maladies may occur. The Artist does not issue refunds the tattoo work has begun. Please make sure your Artist's style and the artwork they provide are of your liking before you begin. We are not responsible for perceived imperfections or poor healing of the tattoo. I agree to reimburse the Artist for any attorneys fees and costs incurred in any legal action I bring against the Artist and in which the Artist is the prevailing party. I agree that the courts of Colorado in Boulder County shall have personal jurisdiction and venue over me and shall have the exclusive jurisdiction for the purpose of litigating any dispute arising out of or related to this agreement. 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. I understand that the Artist rents booth space from Junkyard Ink, LLC and l acknowledge and agree that Junkyard Ink, LLC is in no way liable for any damages arising out of work performed by the Artist or any actions of the Artist whatsoever. To the extent that Junkyard Ink, LLC could be found liable far any damages relating any way to the work performed by the Artist, I release Junkyard Ink, LLC from any and all liability Date MM slash DD slash YYYY Sign inks used : (Color, make and batch #) PhoneBodyArt Location: