Full Name
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Address
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Postal code
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Date of birth
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Phone
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Email
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Do you have Flu Like Symptoms?
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How did you hear about us?
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I will eat at least 4 hours before my tattoo?
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Yes
No
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Do you have any blood pathogens? - it is okay if you do, we need to know for safety reasons.
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Yes
No
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Risks- 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, scaring, difficulties in detecting melanoma and allergic reactions to tattoo pigment, latex gloves, and/or soap. Having been informed of the potential risks, I still wish to proceed with the tattoo and I freely accept and expressly assume and all risks.
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Yes
No
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Waive - To Waive and Release to the fullest extent permitted by law each of the Artist and the 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 any direct and/or consequential damages, which result or arise from my tattoo, whether caused by the negligence or fault of either the Artist or Tattoo Studio, or otherwise.
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Yes
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Influence- 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.
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Yes
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Health- I do not have diabetes, epilepsy, haemophilia, a heart condition, nor do I take blood thinning medication. I do not have any other 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 preventive anti-biotics. I am not pregnant or nursing. I do not have a mental impairment that may affect my judgment in getting the tattoo.
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Yes
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Spelling- 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 chosen from the flash (design) sheets.
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Yes
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Fading- Variations in colour/design may exist between the art I have selected and the actual tattoo. I also understand that over time, the colours and the clarity of my tattoo will fade due to natural dispersion of pigment under the skin.
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Yes
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Permanent- A tattoo is a permanent change to my appearance and can only be removed by laser or surgical means, which can be disfiguring and/or costly and which in all likelihood will not result in the restoration of my skin.
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Yes
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Legal Action- I agree to reimburse each of the Artist and the Tattoo Studio for any attorneys' fees and costs incurred in any legal action I bring against either the Artist or the Tattoo Studio and in which either the Artist or the Tattoo Studio is the prevailing party. I agree that the that the courts of England shall have personal jurisdiction and venue over me and shall have exclusive jurisdiction for the purpose of litigating any dispute arising out of or related to this agreement.
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Yes
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Questions- I acknowledge that I have been given adequate opportunity to read and understand this document, that any and all of my questions have been answered, that it was not presented to me at the last minute, and I understand that I am signing a legal contract waiving certain rights to recover against the Artist and the Tattoo Studio.
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Yes
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Photography- 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 you do not agree with this provision, please advise your Artist).
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Yes
NO
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I hereby declare that I am of legal age (with valid proof of age) and am competent to sign this Agreement in complete understanding and concurrence with this agreement.
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Submit
By providing my contact information, I agree to be contacted from the business.