Cremation Tattoos Client Consent Form

Client Information:
• Name: ________________________________________
• Address: ______________________________________
• Phone Number: _______________________________
• Email: ________________________________________

Tattoo Information:
• Tattoo Description: _______________________________________________
• Location of Tattoo on Body: ________________________________________

Cremation Ashes Information:
• Source of Ashes (e.g., name of deceased, relationship): ______________
• Confirmation of Legal Ownership of Ashes:
I, the undersigned, confirm that I am legally authorized to use the cremation ashes provided for this tattoo, and that I have obtained them from a lawful source (e.g., the cremation process of a deceased loved one).

Risks and Considerations:

I understand that:

  1. Incorporating Cremation Ashes into the Tattoo:
    The use of cremation ashes in a tattoo involves the mixture of cremation ashes with tattoo ink, which will then be applied to my skin through standard tattooing methods. While the ashes are subject to the cremation process, which involves high temperatures designed to eliminate pathogens, no process can guarantee 100% safety or eliminate all potential health risks. There may be potential for allergic reactions, skin irritation, or infection due to the introduction of foreign material into the skin.

  2. Possible Health Risks:
    There are potential health risks associated with the use of cremation ashes, including, but not limited to:

    • Allergic reactions to the ashes or ink mixture

    • Skin irritation or inflammation

    • Infection at the tattoo site, particularly if aftercare instructions are not followed

    • Any other medical complications arising from the introduction of cremation ashes into the skin.

  3. Artist’s Health and Safety Protocols:
    Cremation Tattoos will follow all necessary health and safety protocols to minimize risks, including using sterile equipment, proper handling of the ashes, and adhering to professional hygiene standards. However, I acknowledge that no method can completely eliminate all potential risks.

Consent:

By signing below, I acknowledge that:
• I have provided accurate and truthful information regarding the cremation ashes and my relationship to the deceased person.
• I have fully discussed the tattoo design, placement, and any concerns with the artist.
• I am fully aware of the potential risks involved with the inclusion of cremation ashes in my tattoo, including but not limited to allergic reactions, infection, skin irritation, and other potential health complications.
• I give my explicit consent for the tattoo artist to incorporate the cremation ashes into my tattoo as described above.
• I release the tattoo artist and Cremation Tattoos from any liability related to the use of cremation ashes in my tattoo, including any medical issues or complications that may arise.

Signature of Client: _________________________________
Date: _____________________________________

Artist’s Name: ____________________________
Artist’s Signature: _________________________