• WAIVER FORM

    TIMELESS TATTOO LA
  • Client Information

  • Birth Date*
     - -
  • Format: (000) 000-0000.
  • Appointment Date
     - -
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  • Personally Identifying Information

    Personally identifying information collected on this form will be used only for waiver, safety, and record-keeping purposes related to your service. By submitting this form, you acknowledge that the information provided is accurate to the best of your knowledge and may be retained as part of your client record.

  • Health Release

  • Have you eaten in the last 4 hours?*
  • Have you consumed any alcoholic beverages within the last 8 hours?*
  • Have you consumed any narcotics in the last 24 hours?*
  • Are you pregnant or nursing?*
  • Do you have any medical conditions that we should be aware of prior to your service?*
  • Do you have any communicable diseases, including but not limited to: HIV or Hepatitis ?*
  • Have you suffered from a MRSA infection in the last year?*
  • Are you taking any medications, including but not limited to: blood thinners or antibiotics?*
  • Are you prone to fainting or heavy bleeding?*
  • Do you suffer from keloid or hypertrophic scarring?*
  • Do you suffer from psoriasis or any other skin condition or lesions at the site of the tattoo or piercing?*
  • Do you have any allergies, including but not limited to: latex?*
  • Acknowledgment and Waiver

  • I, the client acknowledge by signing this release that I have been given full opportunity to ask any and all questions I might have about obtaining a tattoo or piercing from the tattoo artist and/or piercer, (Please check below for the tattoo artist/ piercer you are working with and check the box beside that artists name). *(hereafter referred to as "artist") at Timeless Tattoo, and that all of my questions have been answered to my full satisfaction.

    I have recieved full explaination and fully understand the risks associated with obtaining a tattoo or piercing and I am aware that these risks, known and unknown, can lead to injury, including but not limited to, infection, scarring and allergic reaction. Having been informed of these risks, I still wish to proceed with the tattoo or piercing and I fully accept and expressly assume any and all risks that might arise from tattooing and or piercing. I understand that the ink used is not FDA approved and that the health risks are unknown. I hereby release Timeless Tattoo and all of its tattoo artists, piercers and employees from any and all liability, present and future, as well as any and all damages of whatsoever nature, present and future, resulting from obtaining a tattoo and/or piercing. I awknowledge that I will be given instructions on the care of my procedure and will follow these instructions. 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.

    I understand that neither the artist nor Timeless Tattoo is responsible for the spelling of the text or symbol that I have provided them or chosen from the flash sheets. I understand that variations in colour and design may exsist between the art I have selected and the actual tattoo when it is applied to my body, and I am aware that over time the colours and clarity of my tattoo will fade due to unprotcted exposure to the sun and the naturally occuring dispersion of the pigment under the skin. I awknowledge that obtaining this tattoo and or peircing is my choice alone and will result in a permanent change to my apperance, and that no representation whatsoever has been made to me as to the ability to later restore the skin involved in this tattoo to it's pre-tattoo condition. I agree to reimburse both the artist and Timeless Tattoo for any attorney's fees and costs incurred in any legal action that I may bring either against the artist or Timeless Tattoo and in which either the artist or Timeless Tattoo is the prevailing party.

    I agree to release all rights to any photographs and or videos taken of me and the tattoo and or peircing and give consent in advance to their reproduction in print or in electronic form.

    I decalre that I am of legal age and have provided valid proof of age and am competent to sign this agreement. Without limiting the generality of the foregoing, I agree to assume all risk of damage and injury of whatsoever nature to myself or my property, whether directly or indirectly in any manner whatsoever resulting from or in any way arising out of or realted to a tattoo and or peircing of whatsoever nature.

  • Signed Date*
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  • Is the client a minor?*
  • Should be Empty: