Name: * *
Address: * * * * :
Phone: Age: *
* I hereby declare that I am of legal age (and have provided valid proof of age and identification) and am competent to sign this Agreement.
**PLEASE READ CAREFULLY AND INITIAL IN THE BOXES PROVIDED TO SHOW THAT YOU UNDERSTAND EACH PROVISION**
In consideration of receiving services, including any tattoo from Luz Rubio (hereinafter collectively referred to as "luz_tattoos_") including but not limited to, the use of the equipment, injection of ink, facilities, receiving instruction, and the premises (hereinafter collectively referred to as "luz_tattoos_ SERVICES") I acknowledge that I desire to voluntarily receive luz_tattoos_ SERVICES, and I further agree and acknowledge as follows:
* I, * * , have been fully informed of the inherent risks and dangers associated with getting a tattoo. Therefore, I fully understand that these risks, known and unknown, can lead to injury including, but not limited to, possibility of discomfort or pain, permanence of markings, infection, scarring, pain, mental anguish, difficulties in the detection of melanoma and allergic reactions to tattoo pigment, latex gloves, soap, or materials in any equipment or other personal property. Having been informed of the potential risks associated with the tattoo procedure and application, I freely accept and expressly assume any and all risks that may arise from tattooing.
* Luz Rubio (luz_tattoos_) has given me the full opportunity to ask any questions about the procedure and application of my tattoo and all questions, if any, have been answered to my total satisfaction.
* Luz Rubio (luz_tattoos_) has given me both written and verbal instructions on the after care of my tattoo while it is healing. I acknowledge that it is possible that the tattoo can become infected and that I have had ample opportunity to consult a medical doctor prior to the procedure or may need to consult a medical doctor after the procedure.
* I understand I can stop the procedure or the application of my tattoo at any time and for any reason. If any touch-up work to the tattoo is needed, I agree that the work will be done at my own expense, unless the touch-up work is needed to complete the application of the tattoo.
* I am legally able to give consent for the tattoo, I am not under the influence of alcohol or drugs, and I am voluntarily submitting to be tattooed by Luz Rubio (luz_tattoos_). I am not acting under duress or coercion. If any person came with me to Luz Rubio (luz_tattoos_), they have done so as a family member or friend, and not to influence my voluntary decision to consent to be tattooed or pierced.
* I do not suffer from diabetes, epilepsy, hemophilia, or heart condition(s). I do not take blood thinning medication. I do not have any other medical or skin condition that may interfere with the procedure, application or healing of the tattoo. I am not the recipient of an organ or bone marrow transplant. I am not pregnant or nursing. I do not have a mental impairment that may affect my judgement in getting the tattoo.
* I acknowledge it is not reasonably possible for Luz Rubio (luz_tattoos_) to determine whether I might have an allergic reaction to the pigments or processes used in my tattoo, or to any body jewelry or other personal property item and I agree to accept the risk that such a reaction is possible. I acknowledge that there is a possibility of an allergic reaction to colored ink used in tattoos. I understand that Luz Rubio (luz_tattoos_) offers a patch test to determine any potential allergic reactions prior to the tattooing process. It is my responsibility to request and undergo this patch test if I have any concerns about possible allergic reactions. I understand that even with a patch test, there is no guarantee that it will rule out all allergic reactions. By choosing to proceed with the tattoo, whether or not I have undergone a patch test, I accept the risk of any allergic reactions that may occur. I agree not to hold Luz Rubio (luz_tattoos_) liable for any allergic reactions or adverse effects that may arise from the use of colored ink in my tattoo.
* Luz Rubio (luz_tattoos_) is not responsible for the meaning or spelling of the symbol or text that I have provided or that I choose from the flash (design) sheets. Variations in color and design may exist between the tattoo art I have selected and the actual tattoo when it is applied to my body. I also understand that over time, the colors and the clarity of my tattoo will fade for many reasons, including exposure to the sun and the naturally occurring dispersion of pigment under the skin. A tattoo is a permanent change to my appearance. Any procedure to remove, in whole or in part, the tattoo can be disfiguring and costly. Any procedure to remove, in whole or in part, the tattoo will not result in the restoration of my skin to its exact appearance before being tattooed. Luz Rubio (luz_tattoos_) is not responsible for the costs associated with removal, in whole or in part, of the tattoo.
I * the right to any photographs taken of me and the tattoo and * in advance to their reproduction in print or electronic form. I further * Luz Rubio (luz_tattoos_) the right to photograph, videotape, and/or record me and to use the tattoo, my face, likeness, or voice in connection with exhibitions, publicity, advertising, and promotional materials without reservation or limitation. I further agree that if I choose not to release and not to grant the right to photography that I am required to also inform my artist at Studio inks personally.
* I acknowledge that if I arrive more than 10 minutes late to my scheduled appointment without prior notice, a late fee of $35 will be added to the total cost of the service. If I am more than 20 minutes late, Luz Rubio (luz_tattoos_) reserves the right to cancel the appointment, and the deposit will be forfeited Additionally, I understand that if I fail to show up for my scheduled appointment without prior notice, I will be responsible for paying the full quoted amount for the service and that it will be taken directly from the card on file.
* I agree to reimburse Luz Rubio (luz_tattoos_) for any attorneys' fees and costs incurred in any legal action I bring against Luz Rubio (luz_tattoos_) in which the Artist/ Luz Rubio (luz_tattoos_) is the prevailing party. I agree that the courts located in the County of Dallas within the State of Texas shall have jurisdiction and venue over me and shall have exclusive jurisdiction for the purposes of litigating any dispute arising out of or related to this agreement.
I, HEREBY ASSUME ALL RISK AND FULLY RELEASE, ACQUIT, REMISE, WAIVE, COVENANT NOT TO SUE AND FOREVER DISCHARGE TATTOO STUDIO, ITS PARENT, SUBSIDIARIES, AFFILIATES, OTHER RELATED ENTITIES, SUCCESSORS, OWNERS, MEMBERS, DIRECTORS, OFFICERS, SHAREHOLDERS, AGENTS, EMPLOYEES, SERVANTS, ASSIGNS, INVESTORS, LEGAL REPRESENTATIVES AND ALL INDIVIDUALS OR ENTITIES INVOLVED IN THE OPERATIONS OF TATTOO STUDIO, OF AND FROM ANY AND ALL PAST, PRESENT AND FUTURE CLAIMS ARISING FROM THEIR ACTS AND/OR OMISSIONS, INCLUDING BUT NOT LIMITED TO, DEMANDS, OBLIGATIONS, ACTIONS, CAUSES OF ACTION, RIGH TS, DAMAGES, COSTS, NEGLIGENCE CLAIMS, GROSS NEGLIGENCE CLAIMS, ASSAULT CLAIMS, DECEPTIVE TRADE PRACTICE CLAIMS, CONTRACT CLAIMS, INTENTIONAL INFLICTION OF EMOTIONAL DISTRESS CLAIMS, PERSONAL INJURY CLAIMS, PREMISES LIABILITY CLAIMS, PRINCIPAL-AGENT LIABILITY CLAIMS, MENTAL ANGUISH CLAIMS, PAIN AND SUFFERING CLAIMS, PHYSICAL IMPAIRMENT CLAIMS, DISFIGUREMENT CLAIMS, LOST WAGES CLAIMS, LOSS OF EARNING CAPACITY CLAIMS, WARRANTY CLAIMS, PUNITIVE DAMAGES CLAIMS, EXEMPLARY DAMAGES CLAIMS, AND ANY OTHER FORM OF COMPENSATORY CLAIMS OF ANY NATURE WHATSOEVER, WHETHER BASED ON A TORT, CONTRACT, OR OTHER THEORY OF RECOVERY, WHETHER SAME BE KNOWN AND REALIZED OR UNKNOWN AND NOT REALIZED, THAT I, MY ASSIGNEES, HEIRS, DISTRIBUTES, GUARDIANS OR LEGAL REPRESENTATIVES NOW HAVE, HAVE HAD, OR EVER WILL HAVE; FOR INJURY, ILLNESS, DEATH, OR DAMAGE RESULTING FROM BEING TATTOOED, BEING PIERCED, RECEIVING ANY OTHER SERVICE, FROM USING THE PREMISES OF THE TATTOO STUDIO, AND FROM ANY OTHER ACTIVITIES OR SERVICES AND THE RISKS INVOLVED WITH SAME. THIS RELEASE IS INTENDED BY BOTH PARTIES TO BE AS BROAD IN ITS EFFECT AS ALLOWED BY LAW.
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 HAVE CAREFULLY READ THIS WAIVER, RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT IN ITS ENTIRETY AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A WAIVER, RELEASE OF LIABILITY, ASSUMPTION OF RISK AGREEMENT AND A LEGAL CONTRACT BETWEEN ME AND TATTOO STUDIO AND THAT IT AFFECTS MY LEGAL RIGHTS. I AM SIGNING THIS DOCUMENT OF MY OWN FREE WILL. A SIGNED COPY OF THIS DOCUMENT IS AUTHENTIC AND AS EFFECTIVE AS THE ORIGINAL.