Customer Waiver

Below is a standard waiver template, followed by a checklist of legal requirements and best practices for compliance.
Latest Update: 5/21/2025

Tattoo & Body Piercing Consent and Waiver Form

Facility Name: Almont Ink
Facility Address:
134 N. Main St. Almont, MI 48003

Phone Number: 810-214-2817
Licensed by MDHHS: Yes

Client Information:

First Name *

Last Name

Date of Birth *

Email Address *

Phone *

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Government ID # *

Emergency Contact

First Name *

Last Name

Phone *

Services Requested

Service Type *TattooPiercing (Coming Soon)

Tattoo Appointment

Standard Ear

Experience with Tattoos *BeginnerIntermediateAdvanced

Check any of the following conditions you may have experienced *Nonehepatitis, jaundice, or liver diseasebloodborne diseases (e.g., HIV, HBV, HCV)allergies (latex, metals, medications, etc.)taking blood thinners or anticoagulantsskin conditions or infectionspregnant or nursingOther health conditions/concerns

Additional Health Concerns

Acknowledgments and Consent

Age Consent *

I am at least 18 years old (or I am a minor with parent/legal guardian present and written consent as required by Michigan law).

Government Provided ID *

I have valid proof of government provided identification.

Liability Release *

I release Almont Ink LLC, its owners, employees, and agents from all liability for any injury, loss, or damages that may result from this procedure.

Acknowledgment of Risk *

I acknowledge the nature of the procedure and have been informed of the risks, including but not limited to infection, allergic reaction, scarring, and possible complications.

Sterile Equipment Acknowledgement *

I acknowledge that all equipment used is sterile and that universal precautions are observed.

Aftercare Agreement *

I understand and agree to follow all aftercare instructions provided to me.

Consent *

I consent to the procedure(s) described above.

Signature *

Start signing your signature here

Waiver
Aftercare
Safety Steps
Insured
Licensed

Ready to explore your next tattoo project? Contact us today to schedule a consultation and experience the artistry of Almont Ink.

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