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Big Guns Tattoo Oshksoh Consent Form

Let us do this part
Today's Date:
Mon Nov 18 2024 12:01
Practitioner:*
I acknowledge by signing this agreement that I have been given the full opportunity to ask any and all questions which I might have about the obtaining of a tattoo and that all of my questions have been answered to my full satisfaction. I specifically acknowledge I have been advised of the facts and matters set forth below and I agree as follows:
Please read and answer
Y
N
Eaten*
Have you eaten in the past 4hrs? It's a good idea to before hand to increase your blood sugar levels.
Y
N
Medical Conditions *
Do you have epilepsy or hemophilia? Do you suffer from any heart
conditions or take medication which thins the blood? Do you have any conditions
such as diabetes that might affect the healing of the tattoo?
Y
N
Bloodborne Pathogens*
Do you suffer from any other communicable or bloodborne diseases that may affect the healing of your tattoo?
Y
N
Skin Conditions*
Do you have medical or skin conditions such as but not limited to: acne, scarring (keloid), eczema, psoriasis, freckles, moles, or sunburn in the area to be tattooed that may interfere with said tattoo? Do you have any type of infection or rash anywhere on your body?
Y
N
Allergies*
Do you acknowledge it is not reasonably possible for the representative and employees of this tattoo shop to determine whether you may have an allergic reaction to the pigments or processes used in your tattoo? Do you agree to accept the risk that such a reaction is possible?
Y
N
Healing*
Do you acknowledge that infection is always possible as a result of the obtaining of a tattoo, particularly in the event that you do not take proper care of the tattoo? You have received aftercare instructions and agree to follow them while your tattoo is healing. You agree that any touch-up work needed, due to your own negligence, will be done at your own expense.
Y
N
Variations*
Do you realize that variations in color and design may exist between any tattoo as selected by you and is ultimately applied to your body? Do you understand that if your skin color is dark, the colors will not appear as bright as they do on light skin?
Y
N
Skin Treatments*
Do you understand that if you have any skin treatments, laser hair removal, plastic surgery, or other skin altering procedures; it may result in adverse changes to your tattoo?
Y
N
Aftercare*
The Artist and the Tattoo Studio have given you instructions on the care of your tattoo while it's healing, do you understand them and will follow them? You acknowledge that it is possible that the tattoo can become infected, particularly if you do not follow the instructions given to me. If any touch-up work to the tattoo is needed due to your own negligence, you agree that the work will be done at your own expense.
Y
N
Influence *
Are you under the influence of alcohol or drugs? Are you under any duress or coercion to get tattooed?
Y
N
Permanent *
Do you acknowledge that a tattoo is a permanent change to your appearance and that no representations have been made to you as to the ability to later change or remove your tattoo? To your knowledge, you do not have a physical, mental, or medical impairment or disability which might affect your well being as a direct or indirect result of your decision to have a tattoo.
Y
N
Consent
Do you acknowledge you are over the age of eighteen and that you have truthfully represented to the tattooer that the obtaining of a tattoo is by your choice alone? You consent to the application of the tattoo and to any actions or conduct of the representatives and employees of the tattoo shop reasonably necessary to perform the tattoo procedure.
Y
N
Photography*
Do you release all rights to any photographs/videos taken of you and the tattoo and give consent in advance to their reproduction in print or electronic form?
Y
N
COVID-19*
Do you acknowledge contracting COVID-19 is always possible as a result of being in close contact with other people who are, in turn, in contact with more people. You have received information on how Big Guns Tattoo is responding to recommended protocols in addition to their normal precautionary measures and agree that they are not liable if you were to fall ill with COVID-19.
Y
N
Symptoms*
Have you experienced any of the following symptoms in the last 14 days:
Fever, Difficulty breathing, Diarrhea, Dry or wet cough, Runny nose, Sore throat, Fatigue, Aches or pains?
Y
N
Home Life*
Do you feel safe at home?
Details:
 
I hereby release and forever discharge and hold harmless Big Guns Tattoo and all affiliates, Owners, Managers, and Employees from any and all claims, damages or legal actions arising from or connected in any way with my tattoo, or the procedure and conduct used in my tattoo, to the fullest extent allowed by the law. I have been given the full opportunity to ask any and all questions which I might have about how the studio is handling post COVID-19 protocols. I specifically acknowledge I have been advised of the facts and matters set forth above and I agree. I hereby release and forever discharge and hold harmless Big Guns Tattoo and all affiliates, owners, managers, and employees from any and all claims, damages or legal actions arising from or connected in any way with COVID-19 to the fullest extent allowed by the law. I certify under Penalty of Perjury that the above information is true and correct. Should any part of this document be construed as illegal then that part shall be void and the rest shall be held in force as if that part did not exist.
If any provision, section, subsection, clause or phrase of this release is found to be unenforceable or invalid, that portion shall be severed from this contract. The remainder of this contract will then be construed as though the unenforceable portion had never been contained in this document.
Client Information
I hereby declare that I am of legal age (with valid proof of age) and am competent to sign this Agreement.
Legal Name:*
Pronoun:
Chosen name:
Address:
Postcode:
Date of birth:*
You must be 18 or older
Phone #:*
Email:*
Signature:*


Photo ID*
Please take photo(s) of your government issued photo IDs and related paperwork.