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Bunny's Cosmetic Tattoo Waiver

 

 

 

BUNNY’S LIABILITY WAIVER
ACKNOWLEDGEMENT OF BUNNY’S POLICIES 

ARRIVAL+ LATE POLICY: Please aim to arrive 5-10 minutes before your scheduled appointment time with clean/makeup free eyes and lashes. Extra time spent cleaning your lashes will mean less time spent on the lash lift. If you arrive after your scheduled appointment time, it may not be possible to extend the time available for your booked service; if your service is shortened due to your late arrival, you will still be charged the full cost of the service.

CANCELLATION + NO SHOW: A credit card on file is required to book all appointments. As a courtesy, appointment reminders are sent out 48 hours either by text, email or both. If an appointment is cancelled or rescheduled within 24 hours of your appointment, you will be charged 50% of your service as a cancellation fee. If you reschedule or no show your appointment within 4 hours of your scheduled appointment time, you will be charged 100% of your service as a cancellation fee. A one-time allowance of last minute cancellation or reschedule will be permitted for sickness or family emergency. After that, the cancellation and no show policy is in effect.

REFUND POLICY: You are paying for the Artist’s time, product, and other expenses used to provide you with a service. No refunds will be given for any reason on services or products. If you are unhappy with a service, you may contact us within 72 hours of your appointment to discuss your concerns. If a correction can be done to address your concerns, it will be done so with a complimentary 30 minute express touch up if it is at the fault of application or product. Any concerns addressed after 72 hours of your last appointment, or if you failed to follow the proper aftercare instructions, will be charged at the discretion of the artist. 

AFTERCARE: My Artist has gone over the aftercare require to properly maintain and care for the service I am receiving today. I understand that in order to achieve optimal results I must properly adhere to the aftercare instructions that have been provided to me and failure to do so can result in poor healing and pigment retention.

PHOTO CONSENT: I give Bunny’s the absolute right and unrestricted permission to take, use, and display photogenic images of me, through any form of media, print, digital, electronic, broadcast, or otherwise, at any location for art, advertising, media release news articles, marketing, publicity, archival, or any other lawful purpose. I waive any right to royalties or other compensation arising from or related to the use of photogenic images of me. I release and agree to hold harmless, Bunny’s and its employees, associates and representatives from any liability in connection to taking or using said images. 

COSMETIC TATTOO + SALINE REMOVAL WAIVER:

By signing this form I acknowledge that I have been given the full opportunity to ask any and all questions that I might have about obtaining services from Bunny's and that all of my questions have been answered to my full and total satisfation.

I have truthfully represented to Bunny's that I am over 18 years of age.

I am not pregnant or nursing. 

I am not under the influence of alcohol or drugs.

I acknowledge that it is not reasonably possible for the Artists at Bunny's to determine whether I might have an allergic reaction to the agents or processes used in the procedure and I agree to accept the risk that such a reaction is possible.

I have been informed of the nature, risks, possible complications and consequences of permanent skin pigmentation/saline removal. I understand that there are known and unknown complications that can be associated with minor invasive skin treatments, including but not limited to: infection, scarring, inconsistent color, pigment migration, fanning and fading. I understand that the actual color of the pigment may be modified slightly, due to the tone and color of my skin. I fully understand that this is a tattoo process and not an exact science but an art. I request the permanent/semi permanent skin pigmentation procedures as well as any complications of said procedures.

I acknowledge that I have advised my specialist of any condition that might affect the process or healing of this procedure. I do not have any medical or skin conditions such as but not limited to: acne, scarring (Keloids), eczema, psoriasis, frecklles, or sunburn in the area to be tattooed that maybe interfere with my procedure. If I have any type of infection or rash anywhere on my body, I will advise my Artist.

I acknowledge that infection, misplaced pigment, poor color retention and hyperpigmentation are always possible as a result of obtaining a cosmetic tattoo or removal, particularly in the event that I do not follow pre appointment protocols and aftercare. I have received pre and post care instructions and I agree to follow them. I acknowledge that any touch-ups necessary due to my own negligence will be done at my own expense. This includes sun and ultraviolet damage.

I acknowledge that a cosmetic tattoo/saline removal is a permanent change to my appearance, and no representations have been made to me as to the ability to later change, alter or remove my cosmetic tattoo. To my knowledge, I do not have physical, mental or medical impairment or disability which might affect my well being as a direct or indiscreet result of my decision to receive a cosmetic tattoo, and I accept full responsibility for the decision to have this procedure done.

I acknowledge that a certain amount of discomfort is associated with this procedure and that swelling, redness and bruising may occur.

I acknowledge that sleeping on my face, tanning beds, pools, certain active skin care products (including but not limited to Retin A, Renova, Alpha Hydroxy and Glycolic acids) and medications can affect my cosmetic tattoo. I understand that if I receive any skin treatments, laser hair removal, plastic surgery or other skin altering procedures, it may result in adverse changes to my cosmetic tattoo which may not be correctable.

I understand and acknowledge that a second session is required (and possibly more for saline removal) and if I do not follow through with the second session neither my Artist nor Bunny's can be held accountable for the final results.

I acknowledge that successful color saturation can not be guaranteed due to hidden scar tissue.

I accept the responsibility to explain to my Artist my desire for specific colors and shapes for the procedure.

I acknowledge that implanted pigment color can slightly change or fade over time due to circumstances beyond the Artist's and that I may need to maintain the color with future applications.

I agree to immediately notify my Artist immediately if I feel lightheaded, dizzy and/or faint before, during, or after the procedure. Failure to do so releases my Artist and Bunny's of all responsibility.

I acknowledge receipt of written instructions advising me of proper care of my cosmetic tattoo and recognize the absolute necessity of following those written instructions. All questions about the procedure have been answered to my satisfaction.

I acknowledge that obtaining a cosmetic tattoo/saline removal is my choice alone and I consent to the procedure and to any actions or conduct of the Artist's of Bunny's that are reasonably necessary to perform the procedure.

I agree to release and forever discharge and forever hold harmless Bunny's and it's associates from any and all claims, damages, or legal actions arising from or connected in any way with my cosmetic tattoo/saline removal or the procedures and conduct used to apply my cosmetic tattoo and any and all cosmetic tattoos applied by Bunny's and its associates  in the future.

I acknowledge that tattoo inks, dyes, pigments and saline solutions have not been approved by the federal Food and Drug Administration and the health consequences of using these products are unknown.

I acknowledge that I have been fully informed of the risks of cosmetic tattoos/saline removal which includes but is not limited to infection, scarring, difficulties in detecting melanoma and allergic reactions to tattoo pigments, gloves, and topicals. Having been informed of the potential risks associated with receiving a cosmetic tattoo/saline removal I still wish to proceed with the procedure and I assume and all risks that may arise. I accept full responsibility for the decision to receive this service.      

COSMETIC TATTOO + SALINE REMOVAL CONTRAINDICATIONS + APPOINTMENT PRE-CHECK:

Prior to your appointment please be sure to avoid blood thinners, alcohol, ibuprofen, and any other pain relievers 24-48 hours beforehand. Caffeine the day of the procedure may increase discomfort levels and blood flow. It is also advised to avoid exercise 24 hours prior and 10-14 days following your procedure. Those on their menstrual cycle will experience greater sensitivity. No tanning 72 hours before your appointment. For lash line enhancement, please have all eyelash extensions removed prior to your appointment and plan to not wear contact lenses for tow days following. For brows, please discontinue the use of any Retinol, Glycolic, or other acid/active skincare in the brow area 30 days prior to your appointment. More detailed pre-appointment information can be found in your cosmetic tattoo appointment email; I acknowledge that I have received, ready and understood this information and that failure to comply can affect the outcome of my cosmetic tattoo.

Cosmetic Tattoos/Saline Removal Can not be preformed on: Those who are pregnant or breastfeeding, abnormal heart conditions, chronic anxiety, taking immunosuppresion medication, taking blood thinning medication, diagnosed with an immune disorder, tendency to keloid, have received a peel/laser/microneedling within the last two months, taken accutane in the past year, have received forehead Botox injections within 3 weeks, have allergies to makeup/pigments, are undergoing chemotherapy, at high risk of infection, have been diagnosed with trichotillomania, those who have had eye surgery in the last 6 months. I acknowledge that the above conditions do not apply to me and if I have any questions or concerns I have addressed them with my Artist.

COVID-19 WAIVER RELEASE OF LIABILITY AND ASSUMPTION OF RISK
I desire to recieve services from Bunny's. As lawful consideration for the value that I will gain by participating in the Activity, I agree to all the terms and conditions set forth in this agreement (this "Agreement").
I AM AWARE AND UNDERSTAND THAT THE ACTIVITIES ARE POTENTIALLY DANGEROUS ACTIVITIES AND INVOLVE THE RISK OF SERIOUS ILLNESS, INJURY AND/OR DEATH. I ACKNOWLEDGE THAT I AM AWARE OF THE COVID-19 VIRUS AND ITS ABILITY TO BE TRANSFERRED FROM PERSON-TO-PERSON CONTACT. I AM ALSO AWARE THAT ANY PERSON MAY CARRY THE VIRUS AND BE ASYMPTOMATIC. I UNDERSTAND THAT THE COMPANY CANNOT GUARANTEE THAT I WILL NOT BECOME INFECTED WITH COVID-19, DESPITE THE COMPANY’S BEST EFFORTS TO ABIDE BY STATE AND FEDERAL GUIDELINES SURROUNDING COVID-19. I ACKNOWLEDGE THAT I AM VOLUNTARILY PARTICIPATING IN THE ACTIVITIES WITH KNOWLEDGE OF THE DANGER OF ILLNESS INVOLVED AND HEREBY AGREE TO ACCEPT AND ASSUME ANY AND ALL RISKS OF ILLNESS, INJURY, OR DEATH.
I hereby expressly waive and release any and all claims, now known or hereafter known, against the Company, and its officers, directors, employees, agents, affiliates, successors, and assigns (collectively, “Releasees”), on account of illness, injury, or death arising out of or attributable to my participation in the Activities. I agree not to make or bring any such claim against the Company or any other Releasee, and forever release and discharge the Company and all other Releasees from liability under such claims.
I shall defend, indemnify, and hold harmless the Company and all other Releasees against any and all losses, damages, liabilities, deficiencies, claims, actions, judgments, settlements, interest, awards, penalties, fines, costs, or expenses of whatever kind, including attorney fees, fees and the costs of enforcing any right to indemnification under this Agreement, and the cost of pursuing any insurance providers, arising out or resulting from any claim of a third party related to the Activities.
This Agreement constitutes the sole and entire Agreement between the Company and me with respect to the subject matter of release of liability and assumption of risk contained herein and supersedes all prior and contemporaneous understandings, agreements, representations, and warranties, both written and oral, with respect to such subject matter. If any term or provision of this Agreement is invalid, illegal, or unenforceable in any jurisdiction, such invalidity, illegality, or unenforceability shall not affect any other term or provision of this Agreement or invalidate or render unenforceable such term or provision in any other jurisdiction. This Agreement is binding on and shall inure to the benefit of the Company and me and their respective successors and assigns. All matters arising out of or relating to this Agreement shall be governed by and construed in accordance with the internal laws of the State of California without giving effect to any choice or conflict of law provision or rule. Any claim or cause of action arising under this Agreement may be brought only in the federal and state courts located in Los Angeles, California and I hereby consent to the exclusive jurisdiction of such courts.
    BY SIGNING, I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD ALL OF THE TERMS OF THIS AGREEMENT AND THAT I AM VOLUNTARILY GIVING UP SUBSTANTIAL LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE THE COMPANY

 

First Client’s Name

First Name*

Middle Name

Last Name*

Phone*
First Client’s Date of Birth*
First Client’s Signature*
Second Client’s Name

First Name*

Middle Name

Last Name*
Second Client’s Date of Birth*
Third Client’s Name

First Name*

Middle Name

Last Name*
Third Client’s Date of Birth*
Fourth Client’s Name

First Name*

Middle Name

Last Name*
Fourth Client’s Date of Birth*
Fifth Client’s Name

First Name*

Middle Name

Last Name*
Fifth Client’s Date of Birth*
Sixth Client’s Name

First Name*

Middle Name

Last Name*
Sixth Client’s Date of Birth*
Seventh Client’s Name

First Name*

Middle Name

Last Name*
Seventh Client’s Date of Birth*
Eighth Client’s Name

First Name*

Middle Name

Last Name*
Eighth Client’s Date of Birth*
Ninth Client’s Name

First Name*

Middle Name

Last Name*
Ninth Client’s Date of Birth*
Tenth Client’s Name

First Name*

Middle Name

Last Name*
Tenth Client’s Date of Birth*
Client’s 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*
Stay tuned to any Bunny’s news and events!
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*
COSMETIC TATTOO/SALINE REMOVAL MEDICAL QUESTIONNAIRE
Have you had any aspirin or blood thinning products within the last 7 days?*
No
Yes
Have you taken any mod altering drugs within the last 8 hours? (I.e. Wellbutrin, Xanax, Prozac)*
No
Yes
Do you have problems with healing?*
No
Yes
Have you had a chemical or laser peel?*
No
Yes
Have you had previous problems with tattoos or has your physician advised you not to have a tattoo at this time?*
No
Yes
Are you sensitive to latex?*
No
Yes
Are you currently undergoing radiation or chemotherapy?*
No
Yes
Are you currently taking any chemotherapy medications?*
No
Yes
Are you currently using Retin-A or Alpha Hydroxy skin care products?*
No
Yes
Are you allergic to metal?*
No
Yes
Have you had any cosmetic tattoos prior to this appointment?*
No
Yes
Are you taking any immunosuppressive medications including anti-inflammatory or steroids?*
No
Yes
Withdrawal from caffeine products?*
No
Yes
Are you allergic to topical antibiotic numbing creams or desensitizers?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you pregnant or nursing?*
No
Yes
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes
Do you have any drug allergies? If yes, list in the space provided at the end of the form.*
No
Yes
Are you currently taking medication for high or low blood pressure?*
No
Yes
Have you consumed alcohol today?*
No
Yes
Do you have any allergies to the following: soaps, latex, alcohol, cosmetics, adhesives, petroleum, lanolin, lidocaine, carbopol, lecithin, propylene glycol, vitamin E, or epinephrine? If yes please explain in the space provided at the end of this form.*
No
Yes
Do you have/have you had Tuberculosis?*
No
Yes
Do you have/have you had MRSA/STAFF?*
No
Yes
Do you have herpes simplex?*
No
Yes
Do you have any of the following: hepatitis, HIV, jaundice?*
No
Yes
Do you have an organ transplant?*
No
Yes
Do you have kidney disease or a kidney transplant?*
No
Yes
Do you have heart issues, heart diseases or a pace maker?*
No
Yes
Do you have liver disease?*
No
Yes
Do you have keloids or are you prone to scarring?*
No
Yes
Do you have any thyroid issues or take thyroid medication?*
No
Yes
Do you have any auto-immune disorders?*
No
Yes
Do you have Diabetes?*
No
Yes
Do you have a bleeding disorder?*
No
Yes
Do you have any type of cancer?*
No
Yes
Have you had or do you suffer from stroke/paralysis?*
No
Yes
Do you experience chest pains or shortness of breath?*
No
Yes
Do you have Epilepsy/seizures?*
No
Yes
Have you had head trauma/injury?*
No
Yes
Do you have COPD?*
No
Yes
Do you smoke?*
No
Yes
Do you have Glaucoma?*
No
Yes
Do you have/have you had ocular herpes?*
No
Yes
Have you had cataract surgery?*
No
Yes
Do you have tear duct plugs?*
No
Yes
Have you had eyelid surgery?*
No
Yes
Have you had refractive eye surgery?*
No
Yes
Have you had lasik surgery?*
No
Yes
Do you tan regularly?*
No
Yes
Are you using/have you used within the last year accutane?*
No
Yes
Do you have Alopecia?*
No
Yes
Have you had a forehead or brow lift?*
No
Yes
Do you have hyper-pigmentation or hypo-pigmentation?*
No
Yes
Do you have eczema or dermatitis?*
No
Yes
Do you have/have you had shingles on the face?*
No
Yes
Do you have rosacea?*
No
Yes
Do you have vitiligo?*
No
Yes
Do you have severely oily skin?*
No
Yes
Do you use a lash/brow serum?*
No
Yes
Do you have scars in the treatment area?*
No
Yes
Botox in the treatment area? If so please indicate last date of treatment in the notes section.*
No
Yes
Do you have any tumors, cysts or growths in the treatment area?*
No
Yes
Do you experience difficulty numbing?*
No
Yes
Do you currently have any type of illness or infection? If yes please explain in the notes at the end of this section. If you are currently sick or fighting any type of infection your body has limited resources to heal and can compromise the healing process and result of your cosmetic tattoo/saline removal.*
No
Yes

Please use this section to add any further explanations or list medications you are taking, any allergies etc.
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*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
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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