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Relase Form Release Form

Let us do this part
Today's Date:
Mon May 23 2022 02:43
Practitioner:*
Please read and answer
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I am not pregnant or nursing.
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I am not under the influence of alcohol or drugs.
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I am over the age of 18 and have truthfully represented to my tattoo artist that I can legally obtain a tattoo and I consent to the application of the tattoo and to any actions or conduct of the representatives of Thistle & Pearl Tattoo reasonably necessary to perform the tattoo procedure.
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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 the tattoo. I accept full responsibility for my decision and release Thistle & Pearl Tattoo and its representatives from liability for any and all consequences related to this decision.
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I realize that variations in color and design may exist between any tattoos as selected by me and as ultimately applied to my body.
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I am responsible for checking all spelling, dates, initials, etc. applicable to my tattoo.
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I will be given aftercare instructions and understand it is my responsibility to care for my tattoo. I acknowledge that infection is always possible as a result of obtaining a tattoo, particularly in the event that I do not take proper care of my tattoo. I agree that any touch up work needed, due to my own negligence will be done at my own expense.
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I acknowledge it is not reasonably possible for the representatives of Thistle & Pearl Tattoo to determine whether I may have an allergic reaction to the pigments or process used in my tattoo. I agree to accept the risk that such a reaction is possible. I will verbally disclose all known allergies to my tattooer.
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I have reviewed the following list of conditions, acknowledged those that apply to me, and will notify my artist:
HEMOPHILIA
EPILEPSY
HEART CONDITIONS
DIABETES
DIALYSIS TREATMENT
TAKE BLOOD THINNERS AUTOIMMUNE/COMMUNICABLE DISEASES
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I will disclose to my tattoo artist any medications I am currently taking.
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I acknowledge by signing and initialing 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 that I have been advised of the facts and matters set forth above.
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:*
Preferred name:
Address:
Postcode:
Date of birth:*
You must be 18 or older
Phone #:*
Email:
Signature:*


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