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Apothic Tattoo Release Form

Let us do this part

Today's Date:

Tue Apr 1 2025 08:41

Practitioner:*

Tattoo Location:*

Tattoo Price:*

Tattoo Description :*

Artist signature:*

Client Release Form for Apothic Tattoo Studios

Please read and answer

Do you have Flu like symptoms?*

IF YOU HAVE:
- a fever
- flu-like symptoms
- shortness of breath

YOU NEED TO NOTIFY A STAFF MEMBER IMMEDIATELY.

Details:

Information*

Is this your first tattoo?

Emergency Contact*

n the event of an emergency, I am requesting Apothic Tattoo Studio to contact the person(s) listed in the emergency contact section below. In lieu of choosing my own emergency contact, I understand the default emergency contact will be 911 Medical Emergency Services.

Food Intake*

Have you eaten in the past 3 hours? It's a good idea to beforehand to increase your blood sugar levels as avoiding eating may result in passing out or feeling faint.

Pregnancy*

Are you or could you be pregnant?

Health History*

Are you prone to fainting?

Details:

Skin Conditions*

Are you currently experiencing any discoloration, swelling, lumps, sunburn, or any signs of irritation of the body?

Details:

Allergies*

Do you have any allergies? (Please indicate ALL allergies or click “None” if no allergies)

Details:

Health History*

Do you have any blood borne pathogens, transmittable diseases, history of herpes infection or recent illnesses? (If yes, please inform your artist for theirs and the studio’s safety).

Details:

Health History*

I do not have history of bleeding disorders, diabetes, epilepsy, hemophilia, a heart condition, cardiac valve disease, 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 antibiotics. I do not have a mental impairment that may affect my judgment in getting the tattoo.

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 and understand I reserve the right to walk away from any procedure with no questions asked, without a refund, at any time.

Release *

I hereby release and hold harmless Apothic Tattoo Studio LLC and its agents from any and all liability for infection and/or damages that may occur directly or indirectly from said body art procedure.\r\nThat 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, scarring, 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 application and I freely accept and expressly assume any and all risks.

Waiver*

TO WAIVE AND RELEASE to the fullest extent permitted by law of each artist and Apothic Tattoo Studio LLC 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 Apothic Tattoo Studio, or otherwise.

Aftercare*

The Artist and Apothic Tattoo Studio have given me instructions on the care of my tattoo while it\'s healing, and I understand them and will follow them. I acknowledge that it is possible that the tattoo can become infected, particularly if I do not follow the instructions given to me. If any touch-up work to the tattoo is needed due to my own negligence, I agree that the work will be done at my own expense.

Artist Rights*

Neither the Artist nor Apothic 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. I understand it is my responsibility to ensure the text/design is correctly spelled/assembled before the tattoo begins. I also understand that variations in color/design may exist between the art I have selected and the actual tattoo. I also understand that over time, the colors and the clarity of my tattoo will fade due to natural dispersion of pigment under the skin.

Permanence *

I understand this is permanent in nature and may result in scarring to an irreparable degree. I understand there is a healing period following the procedure and it is suggested to adhere to the aftercare regiment. I understand infection can occur with or without proper hygiene. I have no discoloration, swelling, lumps, or any signs of irritation of the body and consider myself healthy enough to request this body art procedure.

Photography*

I grant permission to Apothic Tattoo Studio to photocopy my Government Issue ID card and/or birth certificate; Apothic Tattoo Studio will not share, sell, or use any of my identification information for any reason other than to verify my identity in signing this informed consent, future visits or promotions. I grant permission of any photos taken by Apothic Tattoo Studio Staff to be published publicly or privately and that I relinquish any right to those photos.

Document Confirmation*

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 Apothic Tattoo Studio.

Legal*

I agree to reimburse each of Apothic Tattoo Studio for any attorneys fees and costs incurred in any legal action I bring against either the Artist or Apothic Tattoo Studio and in which either the Artist or Apothic Tattoo Studiois the prevailing party. I agree that the that the courts of Pasco County Florida 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.

Type Age & DOB*

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

Gender:

Nationality:

Phone #:*

Email:*

Social Handle:

If you don't mind us tagging you in photos online

Signature:*

Sign above or type signature:

Emergency Contact

If something happens, your emergency contact might need to explain your medical history, allergies, or medications.

Name:

Phone #:*

Email:*

Address:*

Physician Information

Enter your physician or medical practitioner's contact details or use our suggested default medical facility.

Name:

Contact:

Address:

Photo ID*

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