Tattoo Waiver and Release Form

Tattoo Waiver and Release Form

Please complete this form prior to commencing your tattoo appointment and acknowledge the waiver terms.
Client's Full Name*

First NameLast Name
IC / Passport No.*
Date of Birth*

MonthDayYear
Date
Contact Number

Area CodePhone Number
Emergency Contact (Name & Phone)*
Email Address*
example@example.com
Date of Appointment*

MonthDayYear
Date

Health & Medical Disclosure
I confirm that I am at least 18 years old and NOT under the influence of alcohol or drugs at the time of tattoo procedure.*

I confirm that I am of legal age requirement and not under such influence of substances at the time of the procedure.
I confirm that I DO NOT have the following medical conditions: Hemophilia / Blood disorders, Epilepsy, Diabetes, Keloid-prone skin, allergies to ink, latex, or antiseptics, or Heart or Autoimmune conditions (HIV / AIDS etc).*

I confirm that I do not have the above conditions.
I confirm that I am NOT pregnant or breast-feeding at the time of the tattoo appointment.*

I confirm that the information is true.
Please list down any allergies, medications or medical conditions I should know about. If not applicable, type "None".*

Tattoo Procedure and Aftercare Acknowledgement
I understand and acknowledge that this tattoo is done using the handpoke method / machine and the procedure may cause pain, bleeding, or scarring.*

I acknowledge.
I acknowledge that healing times vary depending on my body and aftercare.*

I acknowledge.
I have received and understand the aftercare instructions and take full responsibility for caring for my tattoo.*

I acknowledge.
I understand that ONLY FIRST touch-ups are free and touch-ups needed subsequently may be charged separately.*

I acknowledge.

Risks & Liability
I release Pokeahontas and Iwani from all claims, liabilities, or damages resulting from the tattoo or procedure.*

I acknowledge.
I understand that the final results of the tattoo may vary based on skin type, placement, how aftercare has been carried out and healing.*

I acknowledge.
I accept all risks involved and understand that it is a voluntary procedure.*

I acknowledge.
I waive the right to pursue legal action for dissatisfaction, infection or complications after the procedure is done.*

I acknowledge.

Copyright & Media Consent
I understand the tattoo design is the intellectual property of Pokeahontas and may not be replicated without the consent of the artist.*

I acknowledge.
Do you agree for your tattoo to be photographed and used as part of portfolio / social media promotional purposes?*

YesNo
Would you like to be tagged on Instagram / Social Media? If yes, please leave your IG handle below.

Signature & Final Consent
By signing below, I confirm that I have read, understood, and agree to all terms of this waiver.
Signature*

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Date*

MonthDayYear
Date
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