Apothika Tattoo Release From
Todays date
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Month
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Day
Year
Date
Choose your artist
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Please Select
Amber Bailey #7894
Aria Justice #8788
Joslin Black #8986
Kiley Miller #9264
Tattoo placement
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Left or right side
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Tattoo design
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Do you have any allergies? Latex, adhesive, soaps etc
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Have you eaten in the last 4 hours? It’s a good idea to maintain blood sugar levels.
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Yes
No
Do you have any blood borne pathogens, transmittable diseases or recents illnesses? (It’s okay if you do, we just want to know for the safety of ourselves and others)
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Yes
No
Risks- I have been fully informed of the inherent risks associated with getting a tattoo. I fully understand that these risks, known and unknown, can lead to injury including but not limited to infection including blood borne pathogens and diseases, scarring, difficulty in detecting melanoma and allergic reactions to tattoo pigment, latex gloves and soap. Having been informed of the potential risks I still wish to proceed with the tattoo application and I freely accept and expressly assume any and all risks.
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Agree
Waiver- To waive and release the the fullest extent permitted by law each of the artists and apothika tattoo from all liability whatsoever, for any 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 my tattoo, whether caused by the negligence or fault or either the artist or apothika tattoo or otherwise.
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Agree
Healing- The Artist and apothika Tattoo have given me instructions on the care of my tattoo while it's healing, and I understand them and will follow them. I acknowledge that it is possible that the tattoo can become infected, particularly if I do not follow the instructions given to me. 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.
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Agree
Influence- I am not under the influence of alcohol or drugs, and I am voluntarily submitting to be tattooed by the Artist without duress or coercion.
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Agree
Health- I do not have diabetes, epilepsy, hemophilia, a heart condition, nor do I take blood thinning medication. (If you do please notify your artist!) I do not have any other condition that may interfere with the application or healing of the tattoo. I am not the recipient of an organ or bone marrow transplant or, if I am, I have taken the preventive anti-biotics. I am not pregnant or nursing. I do not have a mental impairment that may affect my judgment in getting the tattoo.
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Agree
Permanent- A tattoo is a permanent change to my appearance and can only be removed by laser or surgical means, which can be disfiguring and/or costly and which in all likelihood will not result in the restoration of my skin.
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Agree
Legal Action- I agree to reimburse each of the Artist and the apothika Tattoo for any attorneys' fees and costs incurred in any legal action I bring against either the Artist or the Tattoo Studio and in which either the Artist or the Tattoo Studio is the prevailing party. I agree that the that the courts of the United States shall have personal jurisdiction and venue over me and shall have exclusive jurisdiction for the purpose of litigating any dispute arising out of or related to this agreement.
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Agree
Questions- I acknowledge that I have been given adequate opportunity to read and understand this document, that any and all of my questions have been answered, that it was not presented to me at the last minute, and I understand that I am signing a legal contract waiving certain rights to recover against the Artist and apothika Tattoo.
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Agree
Photography- I release all rights to any photographs taken of me and the tattoo and give consent in advance to their reproduction in print or electronic form. (If you do not tick this provision, please advise your Artist).
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Agree
Any person with personal knowledge or information about a violation of the Body Piercing and Tattooing Rules may file a complaint to CHSLicensing@health.ok.gov. More information can be found at https:// oklahoma.gov/health.chs
If any provision, section, subsection, clause or phrase of this release is found to be unenforceable or invalid, that portion shall be severed from this contract. The remainder of this contract will then be construed as though the unenforceable portion had never been contained in this document.
I hereby declare that I am of legal age-18 (with valid proof of age) and am competent to sign this Agreement.
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Agree
Name
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First Name
Last Name
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
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Month
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Day
Year
You must be over 18
Phone Number
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Please enter a valid phone number.
Email
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example@example.com
Signature
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Emergency contact name
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Emergency contact number
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Photo ID
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