Shauncey Fury Tattoo Paperwork

Ask a staff member what to enter

Today's Date:

Fri Apr 19 2024 08:55

Practitioner:*

Please read and answer

Do you have Flu like symptoms?*

IF YOU HAVE:
- a fever
- flu-like symptoms
- shortness of breath

YOU NEED TO NOTIFY A STAFF MEMBER IMMEDIATELY.

Eaten*

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

Bloodbourne Pathogens*

Do you have any bloodbourne pathogens, transmittable diseases or recent illnesses? (It' okay if you do, we just want to know for our and other's safety).

Risks*

I fully understand that tattooing has risks, known and unknown, that can lead to injury, including but not limited to infection, scarring, difficulties in detecting melanoma and allergic reactions to tattoo pigment, nitrile 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 Shauncey Fury and the Dragoncat 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 Shauncey Fury or Dragoncat Tattoo, or otherwise.

Healing*

I understand that Shauncey Fury and Dragoncat Tattoo will provide aftercare instructions on the care of my tattoo while it's healing, and I 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 do not have diabetes, epilepsy, hemophilia, a heart condition, nor do I take blood thinning medication. I do not 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.

Spelling*

Neither Shauncey Fury nor Dragoncat Tattoo is responsible for the meaning or spelling of the symbol or text that I have provided to them or chosen from the flash sheets.I have personally spell checked, and verified that the lettering is correct on the preview paper, and the stencil.

Fading*

Variations in color/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.

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 Shauncey Fury and Dragoncat Tattoo

Photography*

I release the rights to any photographs taken of me & the tattoo, and give consent in advance to their reproduction in print or electronic form.

Any known allergies?*

Location of Tattoo*

Description of Tattoo*

How did you hear about us?

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:*

Social Handle:

If you don't mind us tagging you in photos online

Signature:*

Sign above or type signature:

Emergency Contact

If something happens, your emergency contact might need to explain your medical history, allergies, or medications.

Name:

Phone #:*

Photo ID*

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