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Tattoo

Let us do this part

Today's Date:

Mon May 20 2024 07:30

Practitioner:*

PACIFIC ROSE TATTOO

Please read and answer

COVID-19*

Have you tested positive or have you been in contact with anyone who has tested positive with COVID-19

Details:

Sickness*

Have you had any symptoms of a cold or flu such as a fever, cough, sneezing, runny nose, sore throat, fatigue, OR have been in contact with anyone who has had those symptoms?

Follow up*

You agree to follow up VIA phone or email, if you experience any symptoms of COVID-19 within 14 days of visiting our studio.

Eaten*

Have you eaten in the past 4hrs? It's a good idea to beforehand to increase your blood sugar levels.

Blood-borne Pathogens*

I will disclose any blood-borne infections with my artist. (We will not discriminate or share your status.)

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.

Waive*

TO WAIVE AND RELEASE to the fullest extent permitted by law each of the Artist and the Studio, 1245794 B.C. Ltd. bda Pacific Rose Tattoo 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 my tattoo, whether caused by the negligence or fault of either the Artist or the Tattoo Studio, or otherwise.

Healing*

The Artist and the Tattoo Studio will provide 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.

Influence*

I am not under the influence of alcohol or drugs, and I am voluntarily submitting to be tattooed by the Artist without duress or coercion.

Health*

I agree to disclose to my artist if I have diabetes, epilepsy, hemophilia, a heart condition, if I take blood thinning medication or if I have any other condition that may interfere with the application 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 preventive anti-biotics. I am not pregnant or nursing. I do not have a mental impairment that may affect my judgment in getting the tattoo. If you have/are experiencing one of the above conditions or are on blood thinning medication you agree to notify your service provider.

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 chosen from the flash (design) sheets.

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.

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.

Legal Action*

I agree to reimburse each of the Artist and the Tattoo Studio for any attorneys' fees and costs incurred in any legal action I bring against either the Artist or the Tattoo Studio and in which either the Artist or the Tattoo Studio is the prevailing party. I agree that the that the courts of British Columbia in 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.

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 Tattoo Studio.

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).

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.