Tattoo & Henna/Jagua Procedure Waiver
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
The date of my appointment is
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
DEPOSITS ARE NON-REFUNDABLE. Deposits will be applied towards the final cost of your tattoo at your final session unless your deposit is forfeited. Deposits are forfeited if you: no-show for an appointment, cancel within 5 days advance notice, reschedule more than once (one reschedule), arrive for an appointment more than 30 minutes late, arrive for an appointment without proper ID or arrive intoxicated or otherwise unable to be tattooed, request excessive or last minute changes to the design or concept, do not complete your tattoo within two years, or decide not to get tattooed at all. If you forfeit a deposit, you may be required to leave a new deposit before booking any new appointment(s). Deposits may not be transferred to another person or for use with a different tattooer. Please let us know if you are running late for an appointment. If you are 30 minutes or more late for an appointment without advance notice, you may forfeit your deposit, lose your appointment and be required to reschedule and leave a new deposit. DEPOSITS ARE NONREFUNDABLE.
*
I agree to this statement
I understand that this is a binding contract with Tattoo Studio & I have been given full opportunity to ask any and all questions about my procedure. All of my questions have been answered to my satisfaction. I understand that my procedure may be permanent, and may require surgical procedure for removal. I am aware that removal may cause scarring.
*
I agree to this statement
I do not have any medical conditions or communicable diseases (including but not limited to diabetes, epilepsy, hemophilia, hepatitis, HIV, AIDS, tuberculosis, COVID19). I do not have a skin condition that may interfere with the proper healing of my procedure (including but not limited to acne, scarring or keloids, eczema, psoriasis, freckles, moles, or sunburn). I am not pregnant or nursing. I have informed the agent of Tattoo Studio and documented below of any exceptions to the above. I am not under the influence of drugs, alcohol, or any narcotic, including but not limited to prescription pharmaceuticals, & over the counter medications. I am aware that being under the influence can have an adverse effect on the procedure. I agree that Tattoo Studio cannot determine if I will have an allergic reaction to any of the products used to complete my procedure. I attest that I have no known allergies, or if I do, I have documented them and alerted the artist of the Tattoo Studio.
*
I agree to this statement
I am aware of the possibility of infection with my procedure. I understand that when I leave the premises of Tattoo Studio, my procedure is only half complete. It is my responsibility to follow the aftercare procedures recommended by Tattoo Studio. Tattoo Studio makes no claim to the success or validity of the recommended aftercare procedures, they are simply guidelines. I agree to not hold Tattoo Studio liable for any necessary touch-up work cause by my own negligence. I understand that skin color will have an effect on the final result of my tattoo. I agree to leave the premises of Tattoo Studio promptly upon request, for any reason whatsoever, by any employee or agent of Tattoo Studio. There is no possible way for the Tattoo Studio to know if you will have an allergic response to any of our products or service, and will not be held liable if said response occurs.
*
I agree to this statement
Today's Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
*
Submit
Submit
Should be Empty: