Town of Williamstown, MA Article III Clients

§ 141-10 Application and consent form for body art activity.

Every application and consent form for body art activity shall contain at a minimum:

A. General information regarding body art, including, at a minimum, the following statements:

(1) Tattoos, permanent cosmetics and body piercing should be considered permanent;

(2) Removal of tattoos and permanent cosmetics requires surgery or a medical procedure that may result in scarring of the skin tissue; and

(3) Closure of a hole caused by body piercing may require a medical procedure that may result in scarring of the skin tissue:

B. Information as to side effects of body art, including, but not limited to, hypertrophic scarring, adverse reaction to ink/dye/pigment, change in color of ink/dye/pigment over time, decreased ability of physician to locate skin melanoma in regions concealed by tattoos, nerve damage, febrile illness, tetanus, systemic infection and keloid formation (thick, raised scarring);

C. After-care instructions, including, at a minimum:

(1) Responsibilities and care following the procedure;

(2) Restrictions, if any, upon the client;

(3) Signs and symptoms of infection; and

(4) Instructions to contact a physician if signs of infection occur;

D. Client information, including:

(1) Name;

(2) Age and valid identification;

(3) Parent or legal guardian consent, including name of parent or legal guardian, and proof of parentage or legal guardianship through a copy of a birth certificate or court order of guardianship, respectively, or a notarized document signed by the parent or legal guardian attesting to the parent's or legal guardian's relationship to the client and consent to the conduct of the contemplated body art activity upon the client;

(4) Description of requested body art activity with a list/description of any device/jewelry to be inserted and to remain in body following the body art activity;

E. Instructions requiring client to adhere to the exposure control plan as they relate to client conduct in the body art establishment;

F. Name of body art technician to conduct the body art and corresponding Board permit number;

G. Codes, identity of manufacturer and lot number of any dye and pigment to be used in the body art activity;

H. Signature of client;

I. Signature of clients parent or legal guardian if client is a minor;

J. Signature of body art technician;

K. Date(s) of all signature(s); and

L. Date(s) of procedure, including a daily estimate of progress for the conduct of body art requiring multiple days to complete.