Patchwork Tattoo Waiver

Tattoo Artist: *

Tattoo Artist:*

Client Name*

Pronouns

Email*

example@example.com

Phone Number*

Area CodePhone Number

Date of Birth*

Date

Date of Appointment*

Date

Address*

Street Address

Street Address Line 2

CityProvince

Postal Code

Procedure*

Tattoo design & Placement

I acknowledge I have been advised of the facts and I agree to the following:

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, skin issues, and allergic reactions to tattoo pigment 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.

To waive and release by law each of the Artist and Patchwork Art Studio (the "Studio") and the Operator of 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 Studio.

I understand that all tattoo prices are based on actual time and may vary from the quote given. I am prepared to pay for actual tattoo time at the completion of my appointment.

If I have a health condition I agree to mention it to my Artist. This can include diabetes, epilepsy, hepatitis, hemophilia, communicable diseases, heart condition, skin diseases or if I am taking blood thinning medications. I am not pregnant or nursing. I am not under the influence of alcohol or drugs.

I acknowledge it is not possible for the representatives and Artists of this Studio to determine whether I might have an allergic reaction to the pigments 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 the obtaining of a tattoo, particularly in the event that I do not take proper care of it. I agree to follow aftercare instructions while my tattoo is healing. 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.

I realize that variations in colour and design may exist between any tattoo as selected by me and as ultimately applied to my body. I understand that if I have any skin treatments, laser hair removal, cosmetic surgery or other skin altering procedures, it may result in changes to my tattoo.

I acknowledge that a tattoo is a permanent change to my appearance and do not hold my Tattoo Artist liable.

I acknowledge I am over the age of 18 and that I have truthfully represented to my tattooer that the obtaining of a tattoo is by my choice alone.

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.

I agree to release and discharge my Artist and the Studio from any and all claims, damages, or legal actions arising from or connected to my tattoo and the procedure used in the application of my tattoo.

I consent to the application of the tattoo. My tattoo Artist and I recognize that I may revoke this consent at any time before or during the tattoo procedure.

Signature*

Please check if you have experienced any of the following in the last 14 days*

Have you been in touch with a known or suspected COVID patient or anyone experiencing the above symptoms?*

YesNo

If Yes, describe the circumstance and safety precautions in place.

If not applicable, write N/A

Have you been in touch with a known or suspected COVID patient or anyone experiencing the above symptoms?

YesNo

Are you vaccinated? (Only if you feel comfortable sharing this information, proof of vaccination is not necessary).

Have you travelled outside of Canada in the last 14 days?

YesNo

If Yes, where did you travel from?

If not applicable, write N/A

Have you been following recommended social distancing?*

YesNo

Do you agree to sanitize your hands upon entering the Studio & wear a mask if you’re comfortable?*

YesNo

Liability

I acknowledge that I must comply with all set procedures to reduce the spread while attending my appointment.
I acknowledge the contagious nature of Covid-19 and that tattooing involves being in close contact with others for hours at a time.

I acknowledge that Patchwork Art Studio ("the Studio") and my Artist can not guarantee that I will not become infected with Covid-19.

I understand that this release discharges Patchwork and my Artist from any liability or claim that I may have against the Studio with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from Patchwork and my Artist. This liability waiver and release extends to the Studio together with all Artists.

Signature*

PATCHWORK

Thank you for supporting our Studio!