WAIVER FORM

The following waiver is required to be filled out for each client requesting service during an Inked Circus event. It's purpose is to be able to inform consenting customers of any issue brought forward from Public Health and to protect the Artist by doing our due diligence. Please make sure all information is filled out as it is required by Ontario Public Health.

Thank you, and we hope you enjoy your new Tattoo(s) or Piercing(s).

Inked Circus Expos Inc.

WHICH EXPO CITY ARE YOU CURRENTLY IN?*

WHAT SERVICE ARE YOU GETTING?*

SHOP NAME:*

ARTIST / PIERCER'S NAME:*

ADDITIONAL ARTIST / PIERCER'S NAME: IF MULTIPLE SERVICE or COLLAB.

A CLEAR PHOTO OF ALL THE BLISTER STRIPS (IN 1 PHOTO) FOR YOUR SET UP FOR THIS SERVICE:*

BODY PLACEMENT: (TATTOO or PIERCING):

DESCRIPTION OF TATTOO or PIERCING(s):

Client Name:*

First NameLast Name

Client Email:*

example@example.com

Client Phone Number:*

Please enter a valid phone number.

Client Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

SERVICE WAIVER

"CONSENT TO TATTOO PROCEDURE (WAIVER)
I acknowledge, by signing this agreement that I have been given the full opportunity to ask any and
all questions which I might have about the obtaining of a Tattoo or Piercing and that all of my questions have been
answered to my full satisfaction.
I specifically acknowledge I have been advised of the facts and matters set forth below and I agree
as follows: If I have anemia, diabetes, epilepsy, hepatitis, hemophilia, HIV-AIDS or any other communicable
disease, heart condition or take medicine which this the blood, I have advised my Artist/Piercer.
I am not pregnant or nursing.
I am not under the influence of any alcohol or any drugs. I do not have any medical or skin
conditions such as, but not limited to; acne, scarring (keloid), eczema, psoriasis, freckles, moles or sunburn
in the area to be tattooed/Piercing that may interfere with the above Tattoo/Piercing.
I acknowledge it is not reasonably possible for the representatives and employees of
of the Shop or Artist attending this event or the Staff / organizer of the event to determine whether I might have an allergic
reaction to the pigments or process used in my tattoo and agree to accept the risk that such a reaction is possible.
I acknowledge that infection is always possible as a result of obtaining a tattoo/piercing, particularly in the event
that I do not take proper care of my tattoo/piercing, following the instructions given.
I have received aftercare instructions and I agree to follow them while my tattoo/piercing is healing.
I agree that any touch-up work needed, due to my own negligence, will be done at my own expense.
I realize that variations in skin colour and design may exist between any tattoo selected by me and as
ultimately applied to my body.
I understand that if my skin colour is dark, the colours will not appear as bright as they do on lighter skin.
I understand that if I have any skin treatments, laser hair removal, plastic surgery or other skin altering
procedures, it may result in adverse changes to my tattoo.
I acknowledge that a tattoo is a permanent change to my appearance and that no representations have
been made to me as to the ability to later change or remove my tattoo.
To my knowledge, 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/piercing.
I acknowledge I am over the age of eighteen (18) and that I have truthfully represented to my
tattoo artist/piercer that the obtaining of a tattoo/piercing is by my choice alone.
I consent to the application of the tattoo/piercing and to any actions or conduct of the representatives and
organizer (inked Circus Tattoo Expos Inc.) reasonably necessary to perform the
tattoo procedure.
I WAIVE AND RELEASE to the fullest extent permitted by law, each of the Artists/Piercers in the show and
INKED CIRCUS TATTOO EXPOS Inc. from all liability whatsoever, for any and all claims or
causes of action that I, my estate heirs, executors or assigns may have for personal injury or otherwise,
including any direct and/or consequential damages, which result or arise from the application of my tattoo/piercing,
whether caused by the negligence or fault of either the artist/piercer or the tattoo shop, show organizer or otherwise."

Date

Signature