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PLEASE INITIAL EACH PROVISION AFTER READING TO ACKNOWLEDGE AND UNDERSTAND EACH SECTION.

 

In consideration of receiving a tattoo from YARITZA GARRIDO (tattoo Artist), APPRENTICES AND OR STUDIO.

I agree to the following:

TO WAIVE AND RELEASE to the fullest extent permitted by law that each of the artist and/or apprentices under YARITZA GARRIDO from all liability whatsoever, for any and all claims and causes of actions that I, my estate, heirs, executors or assigns may have for personal injury or damages, which result or arise from the application of my tattoo, whether cause by the negligence or fault of the tattoo artist, apprentice and/or studio or its associates.

That both the artist and or apprentice and or studio have given me the full opportunity to ask and all questions about the application of my tattoo and and all of my questions have been answered satisfactorily. 

The artist/apprentice/studio have given me instructions on the care of my tattoo for the duration of my healing process. I understand and will follow. I acknowledge that it is possible for the tattoo to heal adversely (ex. infection, allergy) In these cases if a touch up is necessary due to my own negligence, I agree that any work will be done at my own expense. In cases of allergy, I WAIVE AND RELEASE any liability and responsibility pursuant to medical care needed.

I am not under the influence of alcohol or drugs, and I am voluntarily submitting to being tattooed by the Artist/Apprentice/Studio 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 tattoo application and its healing. I have notified my artist of any and all medical conditions. I am not the recipient of an organ or bone marrow transplant or, IF I am, I have diligently followed all regimens necessary required by doctors in preparation for procedure, such as tattooing. I am not pregnant or nursing. I do not have a mental impairment that my affect my judgement in getting a tattoo. 

Neither the artist/apprentice or studio is responsible for the meaning/spelling/accuracy for the spelling or symbols or text that I have provided to them or have chosen from any and all sources.

Variations in color and design may exist between the tattoo art I have selected and the actual tattoo when applied to my body. I also understand that over time the colors/ink and the clarity of my tattoo will fade due to unprotected exposures to the sun and naturally occurring dispersion of pigment under the skin, both affected by time and age.

I release all rights to any photographs taken of me and my tattoo and give advanced consent to the reproductions in print of electronic forms.

I agree to reimburse each of the Artist/Apprentice and/or Studio for any attorney fees and costs incurred in any legal action I may bring against any parties listed. I agree that the courts of CONNECTICUT in HARTFORD COUNTY shall be the venue for any litigation arising or related, from this dispute.

I acknowledge that I have been given adequate opportunity to read and understand this document, that it was not presented to me at the last minute and I understand that I am signing a legally binding contract WAIVING certain rights to recover against the artist/apprentice and or studio.

I understand that, from March 1st, 2020 till the remainder of the 2020 calendar year, there is an elevated possibility of risk. I ACCEPT, WAIVE AND RELEASE; Yaritza Garrido from all  all extenuating circumstances that may arise during this time.

I hereby declare that I am of legal age (and have provided valid proof of age) and am competent to sign this agreement. NO ONE UNDER THE LEGAL AGE OF 18 WILL BE ALLLOWED TO OBTAIN A TATTOO EVEN IF PARENTAL CONSENT IS AVAILABLE.

I HAVE READ THIS AGREEMENT, I UNDERSTAND IT, AND AGREE TO BE BOUND BY IT

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, blood borne illnesses, scarring, difficulties detecting melanoma, and allergic reactions to pigments, latex, and or soaps used by artist/apprentice and or studio. I have been informed and wish to proceed with tattoo application and I freely accept, and expressly assume and any all risks that may arise from tattooing. 

November 30, 2022

 

First CLIENTS Name

First Name*

Last Name*

Phone*
First CLIENTS Date of Birth*
First CLIENTS Information
Have you informed your artist of any time/medical restrictions and or concerns?*
No
Yes
First CLIENTS Signature*
Second CLIENTS Name

First Name*

Last Name*
Second CLIENTS Date of Birth*
Second CLIENTS Information
Have you informed your artist of any time/medical restrictions and or concerns?*
No
Yes
Third CLIENTS Name

First Name*

Last Name*
Third CLIENTS Date of Birth*
Third CLIENTS Information
Have you informed your artist of any time/medical restrictions and or concerns?*
No
Yes
Fourth CLIENTS Name

First Name*

Last Name*
Fourth CLIENTS Date of Birth*
Fourth CLIENTS Information
Have you informed your artist of any time/medical restrictions and or concerns?*
No
Yes
Fifth CLIENTS Name

First Name*

Last Name*
Fifth CLIENTS Date of Birth*
Fifth CLIENTS Information
Have you informed your artist of any time/medical restrictions and or concerns?*
No
Yes
Sixth CLIENTS Name

First Name*

Last Name*
Sixth CLIENTS Date of Birth*
Sixth CLIENTS Information
Have you informed your artist of any time/medical restrictions and or concerns?*
No
Yes
Seventh CLIENTS Name

First Name*

Last Name*
Seventh CLIENTS Date of Birth*
Seventh CLIENTS Information
Have you informed your artist of any time/medical restrictions and or concerns?*
No
Yes
Eighth CLIENTS Name

First Name*

Last Name*
Eighth CLIENTS Date of Birth*
Eighth CLIENTS Information
Have you informed your artist of any time/medical restrictions and or concerns?*
No
Yes
Ninth CLIENTS Name

First Name*

Last Name*
Ninth CLIENTS Date of Birth*
Ninth CLIENTS Information
Have you informed your artist of any time/medical restrictions and or concerns?*
No
Yes
Tenth CLIENTS Name

First Name*

Last Name*
Tenth CLIENTS Date of Birth*
Tenth CLIENTS Information
Have you informed your artist of any time/medical restrictions and or concerns?*
No
Yes
CLIENTS Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
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.


By signing below the parent or court-appointed legal guardian agrees that they are also 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*
Parent or Guardian's Information
Have you informed your artist of any time/medical restrictions and or concerns?*
No
Yes
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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