DEFIANCE (TATTOO) CONSENT FORM

Full Name *

First Name Last Name

Age *

Date of Birth *

Date

Phone Number *

Area Code Phone Number

Email *

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

YOU ARE IN GOOD HEALTH AND DO NOT SHOW ANY SIGNS OF COVID19 *

YES NO

HAVE YOU BEEN IN CONTACT WITH ANYONE WITH COVID 19 *

YES NO

HAVE YOU BEEN SICK WITHIN THE PAST 2 WEEKS *

YES NO

YOU HAVE TRAVELED OUTSIDE OF THE PROVINCE IN THE PAST 30 DAYS *

YES NO

YOU ARE REQUIRED TO SELF ISOLATE WITHIN THIS PERIOD OF TIME *

YES NO

TATTOO CLIENT PROTOCOL

ALL CLIENTS ARE REQUIRED TO COME ALONE.

ALL CLIENTS ARE REQUIRED TO WEAR A MEDICAL MASK.

- IF NEEDED WE WILL PROVIDE MASK.

DO NOT SHOW UP EARLY WE ONLY OPEN DOORS AT APPOINTMENT TIME.

DOORS WILL BE LOCKED. (CALL UPON ARRIVAL)

DO NOT BRING UNNECESSARY ITEMS TO APPOINTMENT

IF YOU HAVE ANY COLD/FLU SYMPTOMS CALL TO RESCHEDULE.

UPON ARRIVAL

ALL CLIENTS ARE REQUIRED TO USE HAND SANITIZER.

FOLLOW MARKERS IN STORE / STAFF DIRECTIONS.

ARTIST PROTOCOL

ARTISTS ARE REQUIRED TO WEAR THE PROPER PPE, WHICH CAN INCLUDE FACE PROTECTION, DISPOSABLE BARRIERS AND OTHER PPE DEEMED NECESSARY BY WORK SAFE BC AND FRAZER HEALTH.

ARTISTS MUST SANITIZE ALL SERFACES AFTER EACH CLIENT.

ARTIST MUST USE HAND SANITIZER BEFORE CLIENTS AND BEFORE LEAVING THE STUDIO.

IF ARTIST DISPLAYS FLU LIKE SYMPTOMS THE ARE NOT PERMITTED TO ENTER THE STUDIO AND MUST RESCHEDULE ANY EFFECTED APPOINTMENT.

ARTIST WILL SANITIZE ANY AND ALL SURFACES IN STUDIO INCLUDING ALL DOORHANDLES COUNTERS WAITING AREAS AND STAIR RAILINGS AFTER CLIENT LEAVES.

I AGREE TO FALLOW THE ABOVE PROTOCOLS *

I AGREE

TATTOO AFTER CARE

Leave bandage on for 2 to 4 hours, or artist recommended time.

Remove bandage and thoroughly wash tattoo in warm water with a mild, unscented soap, Never re-TATTOO bandage the tattoo.

Pat your new tattoo dry using a clean paper towel and allow to air-dry for the remainder of the day.

From this point, you will wash the tattoo for no more than 20 seconds a day.

On the third or fourth day, or, when the tattoo begins to dry out, you may begin to apply a thin layer of an unscented, water based moisturizer, no more than twice daily.

Please remember to only use the lotion if the tattoo is feeling dry, tight or itchy. Too little lotion is better than too much.

Do not pick or scratch at the tattoo during healing.

Do not swim or soak the tattoo during healing and keep the tattoo out of direct sunlight.

After healing is complete (about two to four weeks time), always cover the tattoo with sunblock to keep the tattoo looking crisp.

Any deviation from these instructions will void your free touch up. If you have any questions, please contact us directly. Happy healing!

I AGREE I HAVE READ AND UNDERSTAND THE ABOVE TEXT *

I AGREE

*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 getting 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 .

I agree to the following:

if i have diabetes,epilepsy,hepatitis,hemophilia,HIV-AIDS or any other communicable disease, heart condition or take medicine which thins the blood i have advised my tattoo artist.I am not pregnant or nursing.I am not under the influence of alcohol or drugs.

*I acknowledge it is not reasonably possible for the representatives and employees of Defiance to determine i might have an allergic reaction to pigments/ink or processes used in my tattoo,and i agree to accept the risk that such a reaction is possible.

* I acknowledge that infection is always possible as a result of obtaining a tattoo, particularly in the event that i do not take proper care of my tattoo. I have received aftercare instructions and i agree to follow them while my tattoo is healing.i agree that any touch-up work needed, due to my own negligence,will be done at my own expense.

*COVID-19, i agree that i am in good health and have no symptoms of COVID-19 and have not travelled by air or out of province for 14 days, nor live with someone in the same household as a confirmed clinical COVID-19 clinical case who is self isolating, at the time of booking an appointment and prior to entering the studio (Defiance) for a tattoo procedure. i will submit to a temperature check if required. if i am aware of any cold or flu like symptoms i will reschedule and not enter the studio (Defiance).

*I acknowledge I am over the age of eighteen and that i have truthfully represented to my tattoo artist (Sean Kight) that the obtaining of a tattoo is by my choice alone. I consent to the application of the tattoo and to any actions or conduct of Sean Kight reasonably necessary to perform the tattoo procedure.

I AGREE I HAVE READ AND UNDERSTAND THE ABOVE TEXT *

I AGREE

Signed Date *

Date

Client Signature *

Clear

DEFIANCE CONSENT FORM

Client Information

Pre-Procedure Questionnaire

Acknowledgment and Waiver