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Covid-19 Release Form
Let us do this part
Today's Date:
Thu Apr 25 2024 08:44
Practitioner:*
Covid-19 Release Form
Please read and answer
Symptoms*
I confirm that I am not experiencing any of the following:

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

Please note: If you are experiencing any of the following then you will need to self isolate and receive a negative Covid test before you will be allowed to attend the studio.
Self-isolate*
I confirm that in the past 5 days:

- I have not tested positive for Covid-19
- I have not been suspected of having Covid-19.
- I have not had a fever
- I have not travelled to a Covid-19 hotspot either inside or outside of the UK
- I have not been asked to self isolate

Please note: If you have experienced any of these things then you may be required to self-isolate and receive a negative Covid test before being allowed to attend the studio.
Household*
I confirm that no one in my immediate household is currently self isolating after a positive Covid test result, or due to experiencing Covid symptoms.
Risk of infection*
I understand that the Covid virus is extremely contagious and that by choosing to undertake this elective tattoo procedure I will not be able to practice social distancing during my appointment. I am confident that enough safety measure have been taken in the studio to reduce the risks of infection as much as possible and absolve the studio of any responsibility.
Time of arrival*
I will arrive no earlier than 5 minutes before my appointment and understand that I will not be able to wait inside the studio before my appointment begins.
Masks*
Masks are no longer legally required to be worn in the studio but we ask that you bring a mask to your appointment. You may be asked to wear one during the tattoo procedure for the consideration of both you and your artist.
Test & Trace*
I confirm that if I develop Covid symptoms following my appointment I will immediately make the artist/studio aware so that the appropriate actions can be taken.
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.
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:*


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.