Tattoo

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Let us do this part

Today's Date:

Thu May 2 2024 06:21

Location of Tattoo being performed:*

Please read and answer

How did you hear about us?

I'm a regular Yelp Google Personal referral Other

Release*

I HEREBY WAIVE, RELEASE, AND HOLD HARMLESS, to the fullest extent permitted by law, the facility Body Manipulations and its agents 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, whether caused by the negligence or fault of either the Artist or the Facility, or otherwise.

Risks*

I acknowledge that the tattoo will result in a permanent change to my appearance and that my skin may not be restored to its pre-tattooed condition even after its removal. 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. I have been fully informed of the risks, associated with being tattooed. I understand that these risks, known and unknown, can lead to injury, including but not limited to infection, scarring, keloiding, and allergic reactions. Having been informed of the potential risks associated with getting a tattoo, I still wish to proceed with the tattoo and I freely accept all risks that may arise from being tattooed.

Healing Period*

I understand there is a healing period following the procedure and it is suggested to adhere to an aftercare regiment. Suggested aftercare procedures are included in the appropriate aftercare materials furnished post procedure. I understand infection can occur with or without proper hygiene.

Wellness*

Do you have any of the following symptoms: fever, cough, shortness of breath, body aches? If yes, notify our staff immediately.

Eaten*

Have you eaten in the past 3 hours?

Alcohol*

Have you consumed alcohol within the last 12 hours?

Blood*

Do you have any bleeding disorder, hemophilia, diabetes, or cardiac valve disease, any other heart condition, or taking any blood thinning medication?

Pregnant*

Are you pregnant?

Photography*

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.

Sound Mind*

I am fully aware and of sound mind to request this body art procedure and do not wish mutilation or harm upon myself.

This Form*

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 or under duress. I understand that I am signing a legal contract, and I agree to be legally bound by it.

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.

Client Information

I hereby declare that I am of legal age (with valid proof of age) and am competent to sign this Agreement.

Legal Name:*

Pronoun:

Chosen name:

Address:

Postcode:

Date of birth:*

You must be 18 or older

Phone #:*

Email:*

Signature:*

Sign above or type signature:

Photo ID*

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