Covid Release Form Release Form
Let us do this part
Today's Date:
Tue Jan 19 2021 07:50
Practioner:*
COVID Release Form
Please read and answer
Risk of infection*
I understand that the COVID-19 virus is extremely contagious and that by choosing to undertake this elective tattoo procedure I will not be able to practice the social distancing advised during my appointment. I am confident that enough safety measures have been taken in the studio to reduce the risks of infection as much as possible and absolve the studio of any responsibility.
Option to defer*
I acknowledge that I have the option to defer my procedure until after the pandemic has ended but I have chosen to go ahead with my appointment as scheduled.
Time of arrival*
I will arrive no earlier that 5 minutes before my appointment as the studio no longer has a waiting area.
Personal belongings*
All personal belongings will need to be placed in a disinfected box on arrival at the studio and cannot be taken into the tattooing area. As such I will only bring essential items to the studio with me.
Masks*
I agree to follow the statements below while inside the studio:

- I will accept a surgical mask from the studio on arrival.
- I will not pull my mask down from my face whilst in the studio.
- I will not adjust my mask in a way that risks cross contamination.
- If i need to remove my mask for any reason I will step outside of the studio before doing so.
Medical Exemption*
I understand that tattoos are not an essential procedure and as such a medical exemption from wearing masks is not applicable in the studio.

*** Please note: If you are unable to wear a mask then for the safety of both the artists and other customers we ask that you not attend your appointment and reschedule until such time when masks are no longer needed ***
Temperature check*
I consent to having my temperature taken with a contactless thermometer on arrival at the studio.
Y
N
COVID symptoms*
Are you experiencing any of the following symptoms?

- High temperature
- New continuous cough
- Loss/change to sense of smell or taste
- Headaches, muscle/joint aches, or chills
- Tight chest or breathlessness
- Sore throat and/or runny nose

If you have answered yes please provide details
Details:
 

Y
N
Self-isolate*
In the past 14 days have you:

- tested positive or suspected to have had COVID-19?
- Been in contact with someone who has COVID-19 symptoms?
- Had a temperature?
- Travelled to a COVID-19 hotspot either inside or outside the UK?
- Travelled from an area currently in lockdown or partial lockdown?

If you have answered yes to any of these then you may need to self isolate for 14 days and should seek medical advise before attending your appointment.
Household*
I confirm that no one in my immediate household bubble is currently self isolating due to a positive Covid test or because they are displaying Covid symptoms.
Declaration*
I declare that the information I have provided is true and correct to the best of my knowledge. If any person should suffer as a result of the information in this form being found to be untrue or false then I understand that I can be prosecuted for making a false declaration.
Test & Trace*
I confirm that if I develop COVID-19 symptoms following my appointment I will immediately make the artist/studio aware so that appropriate measures can be put in place and contact tracing can commence.
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.
Name:*
Address:*
Date of birth:*
Phone #:*
Email:*
Signature:*