Westcoast Piercing And Ink, Tattoo

Let us do this part

Today's Date:

Fri Oct 3 2025 09:47

Practitioner:*

WAIVER, RELEASE AND CONSENT FOR TATTOOING: PLEASE READ AND BE CERTAIN YOU UNDERSTAND THE IMPLICATIONS OF SIGNING.

In consideration of receiving a tattoo at Westcoast Piercing and Ink & Westcoast Piercing Guy (hereafter referred to as WPG) together with its employees, apprentices and agents, the “Tattoo/Piercing Studio”, I agree to the following:

Please read and answer

RISKS*

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, difficulty in detecting melanoma and allergic reactions to tattoo pigment, latex gloves, and 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 any and all risks that may arise from tattooing.

WAIVER AND RELEASE*

TO WAIVE AND RELEASE to the fullest extent permitted by law each of the Artists and the Tattoo Studio from all liability whatsoever, for any and all claims or causes 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 tattoo, whether caused by the negligence or fault of either the Artists or the Tattoo Studio, or otherwise. In other words, I agree not to sue Westcoast Piercing and Ink & WPG in connection with any and all damages, claims, demands, rights, and causes of action of whatever kind or nature, based upon injuries or property damage to, or death of myself or any other persons arising from my decision to have tattoo work done at this time, whether or not caused by any negligence of Westcoast Piercing and Ink & WPG from all responsibility. I accept any and all responsibility myself for any consequences that might stem from my decision to have tattoo work done by Westcoast Piercing and Ink & WPG or any persons working at any of the Westcoast Piercing and Ink locations(s).

OPPORTUNITY FOR QUESTIONS*

That both the Artist and the Tattoo Studio have given me the full opportunity to ask any and all questions about the application of my tattoo and the staff has answered all of these questions to my total satisfaction.

GIVEN INSTRUCTIONS*

I affirm that both the Artist and the Tattoo Studio have given me instructions on the care of my tattoo while it’s healing, and I understand them and 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. 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.

NO DRUGS OR ALCOHOL*

I affirm that I am not under the influence of alcohol or drugs, and I am voluntarily getting a tattoo without duress or coercion.

LEGAL AGE*

I affirm I am at least 16 years of age (or 18 years for genital) and I have advised my tattooist of all the following conditions that apply to me: heart condition, epilepsy, pregnancy, hepatitis, contagious diseases such and HIV, hemophilia (bleeder), use of blood thinning medication or OTHER medical or skin conditions including psoriasis, warts or eczema that may interfere with the procedure or healing of the tattoo or piercing.

MEDICAL*

m not the recipient of an organ or bone marrow transplant or, if I am, I have taken the prescribed preventive dosage of antibiotics that is required by my doctor in advance of any in invasive procedure such as a tattooing. I am not allergic to adhesives dressings or topical creams, nickel rich alloys such as silver and rhodium, Nitrile or Latex gloves. To my knowledge I do not have any physical, mental or medical impairment or disability which might affect my well-being as a direct result of my decision to have any tattoo work done at this time.

PERMANENT CHANGES TO APPEARANCE*

Neither the Artist nor the Tattoo Studio is responsible for the meaning or spelling of the text or symbol that I have provided to them or chosen from the flash (design) sheets.

VARIATIONS IN COLOR*

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 pigment under the skin.

TATTOO IS PERMANENT*

A tattoo is a permanent change to my appearance and can only be removed by laser 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.

ADEQUATE TIME TO READ THIS DOCUMENT*

I acknowledge that I have been given adequate opportunity to read and understand this document, that it was not presented to me at the last minute, and I understand that I am signing a legal contract waiving certain rights to recover against Westcoast Piercing and Ink & WPG.

REMUNERATION*

I agree to reimburse each of the Artists and the Tattoo Studio for any attorneys’ fees and costs incurred in any legal action I bring against either the Artists or the Tattoo Studio and in which either the Artists or the Tattoo Studio is the prevailing party. I agree that the courts of Surrey in British Columbia, Canada shall have personal jurisdiction and venue over me and shall have exclusive jurisdiction for the purpose of litigating any dispute arising out of or related to this agreement

IF REQUESTED TO LEAVE PREMISES*

I agree to leave the premises of Westcoast Piercing and Ink & WPG or any other establishment where Westcoast Piercing and Ink & WPG is engaged in business promptly upon request, for any reason whatsoever, by any agent or employee of Westcoast Piercing and Ink & WPG. I agree that these waivers also pertain to and are designated to protect any and all establishments where Westcoast Piercing and Ink & WPG conducts business.

PHOTOGRAPHY RIGHTS

I release all rights to any photographs taken of me and the piercing and give consent in advance to their reproduction in print or electronic form. I further agree that Westcoast Piercing and Ink & WPG may use my name, voice, image and likeness, as well as any recording, soundtrack, film or footage (if applicable) in which I appear, solely for advertisement, promotion and training. It is understood that Westcoast Piercing and Ink & WPG will hold all rights to the series or segments, including all property right and copyright, and that Westcoast Piercing and Ink & WPG and its licensees, may make available to the public to broadcast or exhibit the segment and the series and any sequel based on the series, in whole or in part, with no limitation of time or territory, in all languages or version on all formats and media whether now known or developed in the future including television (conventional, cable, pay or satellite TV), home video (VHS,DVD) interactive or non-interactive multimedia (CD-ROM, CDI) and Internet and through derivative works (i.e. literary and visual works. I agree that no monetary compensations and no other consideration is owed by Westcoast Piercing and Ink & WPG to the undersigned with the respect to my participation in the series and the rights transferred and assigned herein. (If you do not initial this provision, please advise and remind your Artist and the Tattoo Studio NOT to take any pictures of you and your completed tattoo!)

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 hereby declare that I am of legal age (and have provided valid proof of age) and am competent to sign this Agreement or, if not, that my parent or legal guardian shall sign on my behalf, and that my parent or legal guardian is in complete understanding and concurrence with this agreement.

I HAVE READ THIS AGREEMENT, I UNDERSTAND IT, I AGREE TO BE BOUND BY IT.
I represent and warrant to Westcoast Piercing and Ink & WPG that the following information is true and correct.
I have read and understand each of the above paragraphs.

Client Information

I hereby declare that I am of legal age (with valid proof of age) and am competent to sign this Agreement or, if not, that my parent or legal guardian shall sign on my behalf, and that my parent or legal guardian is in complete understanding and concurrence with this agreement.

Name:*

Address:*

Postcode:

Date of birth:*

If you are under 16 your parent/guardian will be required

Phone #:*

Email:*

Signature:*

Sign above or type signature:

Photo ID*

Please take photo(s) of your government issued photo IDs and related paperwork.