electronic tattoo release form

WAIVER RELEASE AND CONSENT TO TATTOO

In consideration of receiving a tattoo at KUDZU TATTOO (together with its employees, apprentices and agents the 'Tattoo Studio & Artist"), I agree to the following

First and last name: *

Please enter your full name.

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 associated with getting a tattoo, I still wish to proceed with the tattoo application and freely accept and expressly assume any and all risks that arise from tattooing. *Please check it here.

TO WAIVE AND RELEASE to the fullest extent permitted by law to each of the Artist and the Tattoo 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 the application of my tattoo, whether cause by the negligence or fault of either the Artist or the Tattoo Studio, or otherwise. *Please check it here.

The Artist and the Tattoo Studio have given me the full opportunity to ask any and all questions about the application of my tattoo and all of my questions have been answered to my total satisfaction. *Please check it here.

The artist and the tattoo studio have given me instructions on the care of my tattoo for the healing process, 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. *Please check it here.

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. *Please check it here.

I do not have diabetes, epilepsy, hemophilia, a heart condition, hepatitis, HIV, nor do I take blood thinning medication. I do not have any other medical or skin 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 prescribed preventive regimen of antibiotics that is required by my doctor in advance of any invasive procedure such as tattooing. I am not pregnant or nursing. I have not been pregnant in the past three months. I do not have a mental impairment that may affect my judgement in getting the tattoo. Any health concerns have been made salient before the tattoo procedure. I will inform the artist of any known chronic medical or communicable conditions including a history of diabetes or any disorder or medication that affects the neurological or immune system in fighting infection. A history of bloodborne conditions such as Hepatitis B, Hepatitis C, HIV. A history of hemophilia or any other blood clotting abnormalities. A history of skin disease, skin lesions, or skin sensitivities to soap, disenfects Etc…. A history of allergies or adverse reactions to pigments, dyes, or any other skin sensitivities. A history of epilepsy, seizures, fainting, or narcolepsy. A history of Keloid formation.I am not taking medications such as aspirin or other anticoagulants such as Warfarin, Xarelto, Plavix, Eliquis which thin the blood or interfere with blood clotting. My body artist has informed me to consult a physician prior to the procedure if they have concerns related to the evaluation questions. My body artist has informed me that the health conditions outlined in my evaluation may increase health risks associated with receiving a body art procedure. *Please check it here.

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. *Please check it here.

Variations in color and design may exist between the tattoo art i have selected and the actual tattoo when it is applied to my body. l also understand that over time, the colors and the clarity of my tattoo can be damaged due to unprotected exposure to the sun and the naturally occurring dispersion of pigment under skin. *Please check it here.

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 to its exact appearance before being tattooed. *Please check it here.

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 initial this provision please advise and remind your Artist and the Tattoo Studio Not to take any pictures of you and your completed tattoo! ). *Please check it here.

I agree to reimburse each of the artist and the Tattoo studio for any attorneys' fees and cost 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. *Please check it here.

I acknowledge that I have been given adequate opportunity to read and understand this document, 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. I am obtaining services of my own free will and volition. I have had time to ask questions about the procedure. I have received written and verbal aftercare for the tattoo. *Please check it here.

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.

I hereby declare that I am 18, and have provided valid proof of age, and I am competent to sign this Agreement.

I HAVE READ THIS AGREEMENT, UNDERSTAND IT, AND AGREE TO BE BOUND BY IT.

Zack Spurlock certification number 2469

Meira Yael Ferrera certification number 2743

Please select at least one choice above.

Artist Signature: *

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Please sign here.

First and last name: *

Please enter your full name.

Phone number: *Please enter your phone number.

Please Enter Date: *

Please enter valid date.

Your Signature *

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Please upload the front photo of your Drivers License or ID (Government issued IDs only)

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Please upload image.

Please upload the back photo of your Drivers License or ID (Government issued IDs only)

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Please upload image.

Latex allergy is an immune system response to proteins found in natural rubber latex, which is commonly used in products such as gloves, balloons, and medical devices. People with a latex allergy can experience symptoms ranging from mild skin irritation to severe reactions, including difficulty breathing, swelling, and anaphylaxis. The severity of symptoms can vary depending on the individual and the level of exposure to latex. It is important for individuals with latex allergies to avoid direct contact with latex-containing products and inform others, especially in healthcare or service environments, to minimize the risk of exposure.

Additions to waiver

I am not using numbing creams. Numbing creams can cause complications with healing, and in some events can cause serious chemical burns. I may forfeit my appointment by applying these creams without consulting the artist.

I have eaten a full meal in the past four hours. Proper nutrition is mandatory to endure the process of receiving a tattoo. I will inform the artist applying the tattoo of any light headed effects or dizziness that can come from improper nutrition.

If there are any complications that arise from the tattoo I will notify the artist and seek immediate professional assistance of a doctor.

I will also notify the Chatham county Health Department at (912) 356-2160 I will inform the Health Authority with any question regarding safety, sanitization or sterilization procedures

A short description of image and placement for the tattoo being performed today: *Please enter your answer here.

I the client was asked to provide the information listed in the evaluation and refused

Signature: *

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Please sign here.

Fill out and submit an electronic tattoo release form by using the WaiverElectronic system.

WAIVER RELEASE AND CONSENT TO TATTOO