Ruby Tattoo Studio Tattoo Release Consent Form
Client Information
Full Name
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First Name
Last Name
Age
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Date of Birth
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Month
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Day
Year
Date
Upload Identification (Driver's License, Birth Certificate or Age of Majority card)
Browse Files
Cancel
of
Phone Number
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Area Code
Phone Number
Email
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example@example.com
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Pre-Procedure Questionnaire
COVID-19 SCREENING QUESTIONNAIRE
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I knowingly and willingly consent to having tattoo service(s) during the COVID-19 Pandemic.
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I have not travelled across Canada to other provinces in the past 30 days nor have I been in contact with anyone who has travelled to the best of my knowledge.
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I understand that the COVID-19 virus has a long incubation period during which the carriers of the virus may not show symptoms but may be highly contagious, it is impossible to determine who has it, and who does not have it given the current limits in virus testing.
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I have maintained proper social distancing and have worked as hard as possible to follow all safety procedures to keep myself and others safe (hand washing, face masks, social distancing, isolation, etc.)
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I understand that there is a chance I could contract the infectious COVID-19 virus as well as other pandemic related viruses and I consent to receiving a tattoo procedure knowing the risks of potential exposure and release Ruby Tattoo Studio including associated artists from any responsibility should I fall ill.
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I acknowledge I must wear a face mask in order to enter the studio. If I do not have one, Ruby Tattoo Studio will provide one and I will wear it throughout duration of my appointment without lifting it/removing it or having it fall below the nose.
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I have not experienced any flu-like symptoms nor do I feel ill in any way.
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I will follow all safety guidelines put in place at Ruby Tattoo Studio and maintain proper physical distancing from other staff and clients.
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I understand I must attend my appointment alone and that if I choose to bring any guests (partner, friend, roommate, child, family member, etc.) that they will be turned away at the door and unable to enter the studio.
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I will not bring any food or drink into the studio (sealed new bottled beverages accepted.) nor will I remove/lift my mask to drink unless proper notice is given to my artist so they can maintain safe distance.
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I understand I will not be permitted to bring personal belongings into the shop except for my keys, phone, and purse/wallet.
Are you under the influence of drugs or alcohol?
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Yes
No
Are you Pregnant or Nursing?
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Yes
No
Do you have a communicable disease? (HIV, Hepatitis, etc.)
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Yes
No
Skin conditions (e.g. Rashes, eczema, infection, psoriasis, freckles, etc.)
If yes, please identify the condition.
Medical History (e.g. Diabetes, Cardiovascular Disease, Epilepsy, Blood-related disease etc.)
If yes, please identify the condition.
Allergies:
Acknowledgment and Waiver
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I understand that this procedure is a permanent change to my skin and body.
I have had every opportunity to ask any questions and voice any concerns to my artist.
I will allow my tattoo to be photographed and be used for my artists and tattoo shops portfolio to be showcased.
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I acknowledge that Ruby Tattoo Studio does not offer refunds on any products or services including but not limited to; deposits, gift certificates, artwork, tattoos, commissions, after care and apparel.
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I agree that the studio does not have a way of identifying if I am allergic to the elements or ingredients that will be used for my tattoo and will not be held accountable for any reaction that may arise.
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I am aware that my tattoo may be prone to fading over the years, especially if located in a high traffic area such as on hands or feet and I understand touch ups may not be free if located in high traffic area or if I fail to protect my tattoo properly from the elements including sun damage.
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I acknowledge I have had ample opportunity to check over my design prior to being tattooed on my body. I release Ruby Tattoo Studio and the artists of all responsibility should any spelling errors of words or errors with dates occur.
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I acknowledge that I have had ample opportunity to carefully examine the stencil and design to be tattooed on my body, I approve of the overall design and I understand that it is correct and to my satisfaction upon being placed on my body and that it is my responsibility to communicate with my artist if any changes / repositioning is required prior to being tattooed.
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I understand that I need to take care of the tattoo by following the instructions given to me by my artist and that if I fail to properly care for my tattoo, touch up will be done at my expense.
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I understand that I might get an infection if I don't follow the instructions given to me in regards of taking proper care of my tattoo and I will seek medical attention from my physician immediately should any complications arise.
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I acknowledge there is a chance I might feel light headed, nauseas, anxious and or dizzy during and after getting tattooed, as well as risk fainting.
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I agree to release and forever discharge and forever hold harmless Ruby Tattoo Studio and the artists and representatives from any and all claims, damages or legal actions arising from or connected in any way to my tattoo procedure.
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I confirm that the information I provided in this document is accurate and true.
How did you hear about us?
Artist:
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Danii O'Connor
Lahncey (Purtalic)
Brittany Sterling
Rachel Hamel
Nadia White
Tyler Jessica
Aruna Urquhart
Kat Rotar
Signed Date (enter full date)
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Month
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Day
Year
Date
Client Signature
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Submit
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