TWINS CREEK RELEASE FORM

Twins Creek Tattoo Release Form

73 Sipprelle Dr, Battlement Mesa, CO 81635
Please fill out this form completely and select all that may apply.
Full Name*

First NameLast Name
Phone Number*
Email
example@example.com
Enter Birthdate
Please enter your complete physical address.
Who are you here to see today?*
Please Check Each Box If These Instances Apply to You*

I have NOT come into contact with anyone positive of COVID-19.I am NOT positive for COVID-19.I do NOT have a cold or flu.I am not pregnant or nursing.I do NOT have epilepsy.I do NOT have hepatitis, HIV/AIDS, or any other blood related diseases.I do NOT take blood thinners or medications that could compromise the healing of a tattoo.I do NOT have a heart condition.I am NOT under the influence of drugs or alcohol.I do not have a skin conditions such as but not limited to: acne, Keloid scarring, ecxema, psoriasis, moles, freckles, or sunburn in the area to be tattooed that may interfere with said tattoo. *By checking this box you have been assumed to have advised/consulted with your artist with concerns.*
By Checking Each Box You Acknowledge the Following to Be True:*

I acknowledge it is not reasonably possible for the representatives and sub-contractors/artists of Bonedale Tattoo to determine whether I might have an allergic reaction to a pigment or process used in my tattoo.I acknowledge that infection is always possible as a result of obtaining a tattoo, especially in the event that I do not take proper care of my tattoo.I agree that any touch up work is needed, due to my own negligence, will be done at my own expense.I realize that variations in skin color and design may affect the tattoo outcome in respect to brightness and vibrancy.I acknowledge that a tattoo is a permanent change to my appearance and the placement and design of said tattoo is my choice.I have been made aware that if any signs or symptoms occur, such as fever, unusual swelling, discharge, or odor, I should seek immediate medical attention for evaluation and care from a qualified and licensed professional. *By checking this box you have been assumed to have consulted with your artist with your concerns.*
Are you currently taking any medication or have a condition that may affect your tattoo?*

YesNo
If yes, please explain:
By signing this form you acknowledge the following: that I am over the age of 18, that this form has been filled out by me as honestly and completely as possible, that I do not have a physical, mental or medical impairment or disability which might affect my well-being as a direct or indirect result of my decision to have a tattoo. And most importantly, I have been given the full opportunity to ask any and all questions which I might have about obtaining a tattoo and all questions have been answered to my satisfaction.
Signature*

Clear
Please upload a picture of your valid photo ID.*
***AFTER CARE INSTRUCTIONS WILL BE PROVIDED TO YOU BY YOUR ARTIST. NEGLEGENCE IN THE HEALING PROCESS OF YOUR TATTOO WILL NOT BE FAULTED BY BONEDALE TATTOO. ONCE YOU LEAVE BONEDALE TATTOO YOU ASSUME ALL RISKS AND RESPONSIBLILITES ASSOCIATED WITH GETTING TATTOOED.***
Should be Empty:

Twins Creek Tattoo Release Form