Full Name *

First Name

Last Name

Phone Number *

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Date of Birth *

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DD

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I am at least 18 years of age. *

Yes

I understand that I must present valid government ID and the Tattoo Studio does not tattoo those under 18 years of age. *

I understand

I do not have any allergies, diabetes, epilepsy, hemophilia, hepatitis, HIV, a heart condition, nor do I take blood-thinning medication. I do not have any other medical, blood, or skin condition that may interfere with the application or the healing of the tattoo. I am not the recipient of an organ or bone marrow transplant or, if I am, I have taken the prescribed preventative regimen of antibiotics that is required by my doctor in advance of an invasive procedure such as tattooing. I am not pregnant or nursing. I do not have a mental impairment that may affect my judgment in getting the tattoo. *

I agree

I have been fully informed of the inherent risks associated with getting a tattoo. I fully understand that these risks, known and unknown, can lead to injury or complications, including but not limited to: infection, scarring, bruising, fainting, temporary enlargement of lymph nodes, loss of employment, difficulties in detecting melanoma, allergic reactions to tattoo pigment and death. Having been informed of the potential risks associated with getting a tattoo, I still want to proceed with the tattoo, and I freely accept and expressly assume any and all risks that may arise from tattooing. *

I agree

I agree to waive and release to the fullest extent permitted by law, the artist and Tattoo Studio from 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 the tattoo, whether caused by negligence or fault of either the artist or Tattoo Studio, myself or otherwise. *

I agree

The Artist and the Tattoo Studio have given me the full opportunity to ask any and all questions about the application of my tattoo and all of my questions have been answered to my total satisfaction. *

I agree

Both the tattoo artist and Tattoo Studio have given me instructions on the care of my tattoo while it’s healing (available online before and paper copy to be provided), and I understand and will follow them. I acknowledge that the tattoo can become infected, particularly if I do not follow the instructions given to me. *

I understand

I am not under the influence of alcohol or drugs. *

I agree

I am voluntarily getting a tattoo without duress and understand that I am not under any pressure to receive a tattoo today and I am free to consult a physician before moving forward. *

I agree

I do not want to consult a physician and wish to proceed. *

I agree

Neither the Artist nor the Tattoo Studio is responsible for the meaning or spelling of the symbol or text that I have provided to them. *

I agree

A tattoo is a permanent change to my appearance and can only be removed by laser or surgical means. Variations in colour and design may exist between the tattoo art I have selected and the actual tattoo when it is applied to the body. I also understand that over time, the colours and the clarity of my tattoo will fade due to unprotected exposure to the sun and the naturally occurring dispersion of pigment under the skin. *

I understand

I agree to reimburse each of the Artist(s) and the Tattoo Studio for any Lawyer’s fees and costs incurred in any legal action I bring against either the Artist(s) or the Tattoo Studio and in which either the Artist(s) or the Tattoo Studio is the prevailing party. I agree that the courts of British Columbia, Canada shall have personal jurisdiction for the purpose of litigating any dispute arising out of or related to this agreement. *

I agree

Do you have any surgeries/travel planned within the next 6 weeks? (If yes, please advise artist and reschedule if necessary) *

Yes

No

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 no, please advise artist and remind them not to take photos) *

Yes

No

Have you consumed any blood thinning agents within the last 24 hours? (if yes, please advise artist and reschedule if necessary) *

blood thinning agents include alcohol, aspirin, advil

Yes

No

Are you prone to fainting or lightheadedness? (If yes, please advise artist) *

Yes

No

Have you had anything to eat within the past 4 hours? *

Yes

No, but I will before my appointment

I agree to sit for 15 minutes after my appointment to cool off. *

I agree

I understand that this is a legally binding contract and I have been given the opportunity to thoroughly read and understand this waiver. *

Date

MM

DD

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