Tattoo Release Form
Take a picture of your ID
*
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Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Drivers Licence #
*
Date Of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age
Location of tattoo
Description of Tattoo
Emergency Contact
Name/ and Relation
Phone Number
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Read and Check All The Boxes
*
I am not pregnant
I am free of Communicable Diseases
I have truthfully represented to the associates, agents, representatives of Lunchbox's that I am eighteen (18) years of age or older, have no guardian or committee appointed for me by any court anywhere and am competent and make this release
I understand that it is not reasonably possible for the associates, agents, representatives of Lunchbox's to determine whether I might have any allergic reaction to aftercare ointment or the processes used in the tattoo; and I voluntarily assume and accept all risks that such reactions are possible.
I understand that infection is possible as a result of a tattoo, particularly in the event that I fail to take proper care of my tattoo
I will receive written instructions advising me of the proper care of my tattoo and I recognize the necessity for following these instructions
I understand that a tattoo is a permanent change to my body and appearance and no representation has been made that once made, any tattoo can be altered or removed
My tattoo is by my choice alone. I consent to the Artist and any procedures necessary to perform the tattoo.
I release, forever discharge, and hold harmless Lunchbox's and its apprentices, associates, agents, offers and owners, from and against any and all claims, damages, and/or legal procedures actions arising from or in anyway connected to my tattoo and/or by which my tattoo is applied.
I understand that there are risks involved in the application of a tattoo and there are NO REFUNDS once a tattoo has been paid
I covenant and declare that I am not intoxicated or under the influence of drugs or alcohol.
I do not have epilepsy
I covenant that LBF Inc. may refuse to perform my tattoo at Lunchbox's sole discretion.
I have read this release form and confirm that all the information I have given is correct. I understand that this is a release form and I agree to be legally bound by it.
Check if Applicable
Prone to fainting
Diabetic
Heart Related problems
High Blood pressure
Prone to Seizures
Enter any allergies or medication that may affect the tattoo.
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Your Signature
*
Artist Signature
Should be Empty: