Tattoo Release Form

Let us do this part
Today's Date:
Sun Sep 26 2021 11:45
Practitioner:*
Tattoo Location?:*
What are you getting Tattooed?:*
Please read and answer
 
I am not sick*
I confirm that, I am not sick and I have not been sick in the last 14 days. Also that I have not been around anyone that has been sick in the last 14 days. This includes but is not limited to Covid-19.

Medical Conditions*
-I am not pregnant or nursing.

-If I have diabetes, epilepsy, hemophilia, or a heart condition or take blood thinning medication. I have spoken with the Piercer performing my piercing before hand.

-I do not have any other medical or skin condition that may interfere with the procedure or healing of the Tattoo.

-I am not the recipient of an organ or bone marrow transplant or, if I am, I have taken the prescribed preventive regimen of anti-biotics that is required by my doctor in advance of any invasive procedure such as tattoo.
Y
N
Bloodbourne Pathogens*
Do you have any bloodborne pathogens, transmittable diseases or recent illnesses? (It' okay if you do, we just want to know for our and other's safety).
Y
N
Eaten*
Have you eaten in the past 3hrs? It's a good idea to before hand to increase your blood sugar levels.
Permanent Change*
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.
Risks*
That 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, difficulties in detecting melanoma and allergic reactions to tattoo pigment, latex gloves, and/or soap. Having been informed of the potential risks, I still wish to proceed with the tattoo application and I freely accept and expressly assume any and all risks.
Release*
I waive and release to the fullest extent permitted by law each of the Artist(s), Piercer(s), and Studio(s) 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 the Artist(s), Piercer(s), or Studio(s), or otherwise.
 
I am not under Duress*
I affirm that I am not under the influence of alcohol or drugs, and I am voluntarily getting a tattoo without duress.

No Refunds or Exchanges*
I understand that once the procedure has been preformed and paid for, there are no refunds or exchanges available.
All sales are final.
Attorney Fees*
I agree to reimburse each of the Artist(s), Piercer(s), and Studio(s) for any attorneys, fees, and costs incurred in any legal action I bring against either the Artist(s), Piercer(s), or Studio(s) and in which either the Artist(s), Piercer(s), or Studio(s) is the prevailing party. I agree that the Courts of Cecil County in Maryland 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.
Spelling*
Neither the Artist nor the Tattoo Studio is responsible for the meaning or spelling of the symbol or text that I have provided to them or spelled by the client.
Fading*
Variations in colour/design may exist between the art I have selected and the actual tattoo. I also understand that over time, the colors and the clarity of my tattoo will fade due to natural dispersion of pigment under the skin.
Photography
I release all rights to any photographs taken of me and the tattoo and give consent in advance to their reproduction in print or electronic form. (If you do not tick this provision, please advise your Artist).
I have read this document in full*
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.
Personal Information*
I understand that my information will not be solicited, and is used for Timeless LLC's records per Maryland State Health Regulations and our insurance policy.
Aftercare*
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.
Questions*
I acknowledge that I have been given adequate opportunity to read and understand this document, that any and all of my questions have been answered, 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 the Artist and the Studio.
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.
Personal Info
I hereby declare that I am of legal age (with valid proof of age) and am competent to sign this Agreement.
Legal Name:*
Pronoun:
Preferred name:
Address:*
Postcode:*
Date of birth:*
You must be 18 or older
Phone #:*
Email:*
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Signature:*


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