Big Guns Tattoo FDL Consent Form Release Form

Let us do this part
Today's Date:
Thu Jul 2 2020 07:30
Artist:*
I acknowledge by signing this agreement that I have been given the full opportunity to ask any and all questions which I might have about the obtaining of a tattoo and that all of my questions have been answered to my full satisfaction. I specifically acknowledge I have been advised of the facts and matters set forth below and I agree as follows:
Please read & answer
Eaten*
Have you eaten in the past 4hrs? It's a good idea to before hand to increase your blood sugar levels.
Medical Conditions *
If I have diabetes, epilepsy, hepatitis, hemophilia, HIV-AIDS, or any other communicable disease, heart condition, or take medication which thins the blood; I have advised my tattooer. I am not pregnant or nursing. I am not under the influence of alcohol or drugs.
Skin Conditions *
I have advised my tattoo artist if I have any medical or skin conditions such as but not limited to: acne, scarring (keloid), eczema, psoriasis, freckles, moles, or sunburn in the area to be tattooed that may interfere with said tattoo. If I have any type of infection or rash ?anywhere ?on my body, I will advise my tattooer.
Allergies *
I acknowledge it is not reasonably possible for the representative and employees of this tattoo shop to determine whether I might have an allergic reaction to the pigments or processes used in my tattoo, and I agree to accept the risk that such a reaction is possible.
Healing *
I acknowledge that infection is always possible as a result of the obtaining of a tattoo, particularly in the event that I do not take proper care of my tattoo. I have received aftercare instructions and I agree to follow then while my tattoo is healing. I agree that any touch-up work needed, due to my own negligence, will be done at my own expense.
Variations *
I realize that the variations in color and design may exist between any tattoo as selected by me and as ultimately applied to my body. I understand that if my skin color is dark, the colors will not appear as bright as they do on light skin.
Skin Treatments*
I understand that if I have any skin treatments, laser hair removal, plastic surgery, or other skin altering procedures; it may result in adverse changes to my tattoo.
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.
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.
Permanent*
I acknowledge that a tattoo is a permanent change to my appearance and that no representations have been made to me as to the ability to later change or remove my tattoo. To my knowledge, I do not have a physical, mental, or medical impairment or disability which might affect my well being as a direct or indirect result of my decision to have a tattoo.
Consent *
I acknowledge I am over the age of eighteen and that I have truthfully represented to my tattooer that the obtaining of a tattoo is by my choice alone. I consent to the application of the tattoo and to any actions or conduct of the representatives and employees of the tattoo shop reasonably necessary to perform the tattoo procedure.
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).
COVID-19*
I acknowledge contracting COVID-19 is always possible as a result of being in close contact with other people who are, in turn, in contact with more people. I have received information on how Big Guns Tattoo is responding to recommended protocols in addition to their normal precautionary measures and agree that they are not liable if I were to fall ill with COVID-19.
Traveled *
Have you traveled in the last 14 days?
Contact*
To your knowledge, have you been in contact with someone with COVID-19 or anyone in quarantine suspected of having COVID-19?
High Risk *
Do work in a high risk job? (ie. Hospital, childcare, grocery store clerk, etc.)
Symptoms*
Have you experienced any of the following symptoms in the last 14 days:
Fever, Difficulty breathing, Diarrhea, Dry or wet cough, Runny nose, Sore throat, Fatigue, Aches or pains?
Social*
Have you been to any bars or other locations where large crowds of people gather in the last 14 days?
I hereby release and forever discharge and hold harmless Big Guns Tattoo and all affiliates, Owners, Managers, and Employees from any and all claims, damages or legal actions arising from or connected in any way with my tattoo, or the procedure and conduct used in my tattoo, to the fullest extent allowed by the law. I have been given the full opportunity to ask any and all questions which I might have about how the studio is handling post COVID-19 protocols. I specifically acknowledge I have been advised of the facts and matters set forth above and I agree. I hereby release and forever discharge and hold harmless Big Guns Tattoo and all affiliates, owners, managers, and employees from any and all claims, damages or legal actions arising from or connected in any way with COVID-19 to the fullest extent allowed by the law. I certify under Penalty of Perjury that the above information is true and correct. Should any part of this document be construed as illegal then that part shall be void and the rest shall be held in force as if that part did not exist.
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:
Prefered name:
Address:
Date of birth:*
You must be 18 or older
Phone #:*
Email:*
Signature:*


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