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The Gallows Tattoo Release Form
Let us do this part
Today's Date:
Sat Apr 26 2025 02:43
Practitioner:*
Tattoo Location on Body:*
Please read and answer
COVID-19*
I AFFIRM TO THE BEST OF MY KNOWLEDGE that I & members of my immediate family (and/or household), are not currently sick & in the last 30 days: have not been sick, have not been in contact with anyone that is sick, & have not travelled outside of the country.
I UNDERSTAND The Gallows Tattoo Studio has put additional protective measures in place in order to further minimize the risk of exposure to any contamination, virus, or pathogen. I also understand it impossible to completely eliminate that risk.
I AGREE to follow The Gallows Tattoo Studio’s protective measures and wear the PPE given to me for the duration of my appointment.
I UNDERSTAND I WILL BE TATTOOED using appropriate sterile instruments & aseptic technique. To ensure proper healing of my tattoo & to prevent contracting any type of infection or illness (including, but not limited to MRSA & COVID-19),
I AGREE to stringently follow the aftercare suggestions outlined in the written tattoo aftercare instructions provided to me until the healing process is complete.
I UNDERSTAND that a tattoo usually takes 2 weeks or longer to heal. I understand that getting tattooed does temporarily stress the body and the immune system, which could make me more susceptible to illness & infection.
Eaten*
I have eaten within the last 4 hours, and am in a good physical state to receive my tattoo.
Payment*
Do you have cash to pay for your tattoo? If you are using Venmo or Cash app, please notify your artist prior to the start of the tattoo.
Bloodbourne Pathogens*
I do not have any bloodbourne pathogens, transmittable diseases, or recent illnesses.
Health*
I do not have diabetes, epilepsy, hemophilia, 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.
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 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.
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 the Tattoo Studio, or otherwise.
Healing*
The Artist and the 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.
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.
Spelling*
Neither the Artist nor The Gallows 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.
Fading*
Variations in colour/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.
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.
Legal Action*
I agree to reimburse each of the Artist and The Gallows Tattoo Studio for any attorneys' fees and costs incurred in any legal action I bring against either the Artist or The Gallows Tattoo Studio and in which either the Artist or the Tattoo Studio is the prevailing party. I agree that the courts of Wayne County in the state of Michigan 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.
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 tick this provision, please advise your Artist).
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 Gallows Tattoo Studio.
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:*
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.