TATTOO RELEASE FORM

I HEARBY AGREE TO THE FOLLOWING

Artist Name Completing Tattoo*

To be tattooed by the artist listed above. To be tattooed by Cloak and Dagger Tattoo and in consideration of doing so, release Cloak and Dagger Tattoo and it's employees and agents from all manner of liabilities, claims, actions, and/or demands in law or equity, which I or my heirs have or might have now or hereafter by reason of complying with my request to be tattooed.

Initials for Release of all liabilities etc. (Details Above)*

I fully understand that any employee or agent of Cloak and Dagger Tattoo, when performing tattooing procedures, does not act in the capacity of a medical professional. The suggestions made by any employee or agent of Cloak and Dagger Tattoo are just , suggestions and are not to be construed or substituted for advice from a licensed medical practitioner. I understand that I will be tattooed using appropriate instruments and techniques.

Initials for advice not to be considered medical (details above)*

To ensure proper healing of my tattoo I agree to follow the aftercare procedures in the "Aftercare Brochure" until healing is complete. I understand that tattoos may take 7-21 days or longer to FULLY HEAL. I willingly submit to these procedures with full comprehension of possible complications including, but not limited to permanent scarring, post procedure infection, and allergic reaction. FINAL SPELLING AND PLACEMENT FOR MY TATTOO IS SOLELY MY RESPONSIBILITY.

Type Your Initials here to Consent to aftercare procedures (details above)*

BY MY SIGNATURE BELOW, I CERTIFY that i am 18 years old or older, and I have received a copy of the ''Tattoo Aftercare" Brochure which I have read and hereby take full and all responsibility for aftercare and cleanliness. I understand that by having this tattoo procedure performed I am making a permanent change to my body and no claims have been made regarding the ability to undo, alter, or hide the changes made. I further understand that if I give false information or produce false documents stating my name and age to be anything other than correct, I will be liable for prosecution. THE MONTGOMERY COUNTY HEALTH BOARD'S issuance of Cloak and Dagger Tattoo's license to operate certifies that this facility has been inspected and has been found to meet or exceed the requirements of the health board.

Type Your Initials here to certify that you are 18 years or older (details above)*

Have you eaten in the last 24 hours?*

YesNo

Have you had an alcoholic beverage in the last 8 hours?*

YesNo

Have you taken aspirin, ibuprofen, or anticoagulants in the last 24 hours?*

YesNo

Are you prone to heavy bleeding*

YesNo

Do you have latex allergies?*

YesNo

Do you have any other allergies? If yes, please use the box at the bottom to explain.*

YesNo

Are you pregnant?*

YesNo

Do you have any condition (i.e., diabetes, hemophilia) which might affect the healing of your tattoo? If yes, please use the box at the bottom to explain.*

YesNo

Please use this space to further explain any items checked "yes" above.

How did you hear about us?

Name*

First NameLast Name

Phone Number*

Please enter a valid phone number.

Emergency Phone*

Please enter a valid phone number.

Emergency Contact Name*

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Age*

Date

MonthDayYear

Signature

Cloak and Dagger Tattoo

1100 Wilmington Ave. Dayton, OH 45420

booking@cloakanddaggertattoo.com (937) 222-7880

https://www.cloakanddaggertattoo.com/client-release-form

TATTOO RELEASE FORM

CONTACT INFORMATION