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172 James St. North
Hamilton, On
L8R3J6

289-389-7878

 

 

Thank you for choosing Grey Harbour Tattoo!

Please read though this waiver release carefully. 

I acknowledge by reading and signing this Release Form that I have been given full opportunity to ask any and all questions that I might have obtaining a tattoo and that all my questions have been answered to my full satisfaction. 


If I have any questions, I have inquired with my tattoo artist and have been given all details as requested. 

I specifically acknowledge that I have been advised of the facts and details set forth below and agree as follows:

Please select who will be getting tattooed...
AdultMinor
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First Clients Name

First Name*

Middle Name

Last Name*

Phone*
First Clients Date of Birth*
First Clients Information
Artist
Please checkmark if you have any allergies to the following:
Adhesives
Alcohol
Antibiotics
Bees wax
Cosmetics
Lanolin Oil
Latex
Lidocaine
Metals
Petroleum
Shellfish
Soaps
Body Location of Tattoo*

Description of Tattoo *
Please check mark if you have or been exposed recently to the following:
Asthma
Auto-Immunity
COVID-19
Gonorrhea
Hepatitis
Herpes
HIV/AIDS
Infections
Staph
Syphilis
Tuberculosis

Please list medications, if any:
Please check mark if you have any of the following health conditions:
Diabetes
Hemophilia
Eczema
Prone to Faintness
Epilepsy
Heart Disease
High Blood Pressure
Pregnant
Prone to Scarring/Keloiding
Psoriasis
Skin Disease/Rash
Breastfeeding

If not listed above, please specify:
Have you eaten within the last 4 hours?*
No
Yes
I acknowledge that Grey Harbour Tattoo is not responsible whether I might have an allergic reaction to the dyes, pigments or processes used in my tattoo, and agree to accept the risk that such a reaction is possible.*
No
Yes
Due to the current climate of events impacted by COVID-19, I have followed proper procedures and guidelines before entering Grey Harbour Tattoo Studio and adhere to following Grey Harbour Tattoo's code of conduct towards COVID-19 regulations.*
No
Yes
I have truthfully represented to Grey Harbour Tattoo that I am over eighteen (18) years of age.*
No
Yes
Are you under the influence of drugs and/or alcohol?*
No
Yes
I acknowledge that if my tattoo is a symbol or something written in a language other than English, the tattoo artist and owners of the business are not responsible for what it may or may not mean.*
No
Yes
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.*
No
Yes
I agree that any touch up work needed due to my own negligence will be done at my own expense. This includes sun and ultraviolet frequency damage.*
No
Yes
I acknowledge that a tattoo is a permanent change to my appearance. To my knowledge, I do not have any physical, mental or medical impairments or disabilities which might affect my well being as a direct or indirect result of my decision to get a tattoo.*
No
Yes
I acknowledge consent to the location of my tattoo and the performance of the tattoo procedure.*
No
Yes
I acknowledge that if my tattoo includes text that I am responsible for the correct spelling, grammar and punctuation and ghost you have proofed the text before it is applied.*
No
Yes
I acknowledge that variations in colour and design may exist between any tattoo as selected by me based off tonal variations of skin pigment and how it influences the value of ink pigment particles.*
No
Yes
I acknowledge and agree to following any and all instructions provided to me regarding the maintenance of a sanitary environment while I am being tattooed.*
No
Yes
I agree to immediately notify the artist if I feel light headed, dizzy, and/or faint before. During or after the procedure. Failure to do so releases Grey Harbour Tattoo and my tattoo artist of all responsibility.*
No
Yes

Preferred name if desired:
Preferred Pronoun:
First Clients Signature*
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

First Name*

Last 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*

Middle Name

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
Artist
Please checkmark if you have any allergies to the following:
Adhesives
Alcohol
Antibiotics
Bees wax
Cosmetics
Lanolin Oil
Latex
Lidocaine
Metals
Petroleum
Shellfish
Soaps
Body Location of Tattoo*

Description of Tattoo *
Please check mark if you have or been exposed recently to the following:
Asthma
Auto-Immunity
COVID-19
Gonorrhea
Hepatitis
Herpes
HIV/AIDS
Infections
Staph
Syphilis
Tuberculosis

Please list medications, if any:
Please check mark if you have any of the following health conditions:
Diabetes
Hemophilia
Eczema
Prone to Faintness
Epilepsy
Heart Disease
High Blood Pressure
Pregnant
Prone to Scarring/Keloiding
Psoriasis
Skin Disease/Rash
Breastfeeding

If not listed above, please specify:
Have you eaten within the last 4 hours?*
No
Yes
I acknowledge that Grey Harbour Tattoo is not responsible whether I might have an allergic reaction to the dyes, pigments or processes used in my tattoo, and agree to accept the risk that such a reaction is possible.*
No
Yes
Due to the current climate of events impacted by COVID-19, I have followed proper procedures and guidelines before entering Grey Harbour Tattoo Studio and adhere to following Grey Harbour Tattoo's code of conduct towards COVID-19 regulations.*
No
Yes
I have truthfully represented to Grey Harbour Tattoo that I am over eighteen (18) years of age.*
No
Yes
Are you under the influence of drugs and/or alcohol?*
No
Yes
I acknowledge that if my tattoo is a symbol or something written in a language other than English, the tattoo artist and owners of the business are not responsible for what it may or may not mean.*
No
Yes
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.*
No
Yes
I agree that any touch up work needed due to my own negligence will be done at my own expense. This includes sun and ultraviolet frequency damage.*
No
Yes
I acknowledge that a tattoo is a permanent change to my appearance. To my knowledge, I do not have any physical, mental or medical impairments or disabilities which might affect my well being as a direct or indirect result of my decision to get a tattoo.*
No
Yes
I acknowledge consent to the location of my tattoo and the performance of the tattoo procedure.*
No
Yes
I acknowledge that if my tattoo includes text that I am responsible for the correct spelling, grammar and punctuation and ghost you have proofed the text before it is applied.*
No
Yes
I acknowledge that variations in colour and design may exist between any tattoo as selected by me based off tonal variations of skin pigment and how it influences the value of ink pigment particles.*
No
Yes
I acknowledge and agree to following any and all instructions provided to me regarding the maintenance of a sanitary environment while I am being tattooed.*
No
Yes
I agree to immediately notify the artist if I feel light headed, dizzy, and/or faint before. During or after the procedure. Failure to do so releases Grey Harbour Tattoo and my tattoo artist of all responsibility.*
No
Yes

Preferred name if desired:
Preferred Pronoun:
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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