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PLEASE READ AND BE CERTAIN YOU UNDERSTAND THE IMPLICATIONS OF SIGNING

THIS DOCUMENT IS TWO PAGES, PLEASE INITIAL EACH PROVISION ON THE LINES PROVIDED AFTER READING TO SHOW THAT YOU UNDERSTAND EACH PROVISION.

 

All Deposits are NON-REFUNDABLE. Please give us at least 4 hours notice if you need to reschedule you appointment. No shows result in a forfeiture of the deposit amount. Please arrive on time for your appointment so other clients are not inconvenienced. We reserve the right to ask you to reschedule if you arrive after your scheduled appointment time.   

WAIVER, RELEASE AND CONSENT TO TATTOO

In consideration of receiving a tattoo (the Artist) at East Van Inc Custom Tattoo & Clothing. (Together with its employees, apprentices and agents, the “Tattoo Studio”). I agree to the following:

That 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 including but not limited to infection, scarring, and difficulties in detecting melanoma and allergic reactions to tattoo pigment, latex gloves, and/or soap. Having being informed of the potential risks associated with getting a tattoo, I still wish to proceed with the tattoo application and I freely accept and expressly assume and all risks that may arise from tattooing.

To WAIVE AND RELEASE to the fullest extent permitted by law, each of the Artist and Tattoo Studio 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 and direct and/or consequential damages, which result or arise from the application of my tattoo, whether caused by negligence or fault of either the Artist or the Tattoo Studio or otherwise.

That both 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.

The Artist and the Tattoo Studio have given me instructions on the care of my tattoo while it is healing, and I understand them and will follow them. I acknowledge that it is possible that the tattoo can become infected, particularly if I do not follow the instruction 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 down at my own expense.

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.

I do not have Diabetes, Epilepsy, Hemophilia, a heart condition, nor do I take blood-thinning medication. I do not have any other medical or skin 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 prescribed preventative regimens of antibiotics that is required by my doctor in advance of any invasive procedure such as tattooing or piercing, I am not pregnant or nursing. I do not have a mental impairment that may affect my judgment in getting the tattoo.

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 or chose from the flash (design) sheets.

Variations in color and design may exist between the tattoo art I have selected and the actual tattoo when it is applied to my body, I also understand that over time, the colors 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.

Today's Date: May 28, 2020

 

First Clients Name

First Name*

Last Name*

Phone*
First Clients Date of Birth*
I certify that I am 18 years of age or older
First Clients Information

Description of tattoo

Placement of tattoo

Date of inking
First Clients Signature*
Second Clients Name

First Name*

Last Name*
Second Clients Date of Birth*
Second Clients Information

Description of tattoo

Placement of tattoo

Date of inking
Third Clients Name

First Name*

Last Name*
Third Clients Date of Birth*
Third Clients Information

Description of tattoo

Placement of tattoo

Date of inking
Fourth Clients Name

First Name*

Last Name*
Fourth Clients Date of Birth*
Fourth Clients Information

Description of tattoo

Placement of tattoo

Date of inking
Fifth Clients Name

First Name*

Last Name*
Fifth Clients Date of Birth*
Fifth Clients Information

Description of tattoo

Placement of tattoo

Date of inking
Sixth Clients Name

First Name*

Last Name*
Sixth Clients Date of Birth*
Sixth Clients Information

Description of tattoo

Placement of tattoo

Date of inking
Seventh Clients Name

First Name*

Last Name*
Seventh Clients Date of Birth*
Seventh Clients Information

Description of tattoo

Placement of tattoo

Date of inking
Eighth Clients Name

First Name*

Last Name*
Eighth Clients Date of Birth*
Eighth Clients Information

Description of tattoo

Placement of tattoo

Date of inking
Ninth Clients Name

First Name*

Last Name*
Ninth Clients Date of Birth*
Ninth Clients Information

Description of tattoo

Placement of tattoo

Date of inking
Tenth Clients Name

First Name*

Last Name*
Tenth Clients Date of Birth*
Tenth Clients Information

Description of tattoo

Placement of tattoo

Date of inking
Parent or Guardian's Email Address

Email*

Confirm Email*
Parent or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information

Description of tattoo

Placement of tattoo

Date of inking
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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