• TATTOO RECORD AND RELEASE FORM

    607 6th Avenue Dayton, Kentucky 41074

  • Client Contact Information

  • Today's Date
  • Format: (000) 000-0000.

  • Artist & Tattoo Information

  • Artist's Name*

  • Client Health Information

  • Have you had any drugs or alcoholic beverages in the last 8 hours?*
  • Do you have hemophilia, anemia, or diabetes?*
  • Are you pregnant?*
  • Do you have a defibrillator or pacemaker?*
  • Have you ingested any anticoagulants/blood thinners in the last 24 hours?*

  • Client Waiver & Signature

  • Please read and sign at the bottom of this page:

    • I am at least 18 years of age.
    • I am not a hemophiliac.
    • I am not under the influence of any drugs or alcohol.
    • I am not pregnant.
    • I do not have a heart condition.
    • I am not diabetic or on any blood-thinning medication.
    • I am not allergic to any dyes or pigments that I am aware of, that may cause severe asthmatic or allergic reactions.
    • To the best of my knowledge, I do not have any mental, physical, or medical conditions which may affect my wellbeing as a direct or indirect result of my decision to obtain a tattoo at this time.
    • I agree to follow all instructions concerning the care of my tattoo during the healing process.
    • I agree that touch-up work needed due to my negligence will be at my own expense.
    • I understand that different skin complexions can show ink color differently.
    • I will take into consideration and accept the artist's opinion on these matters.
    • I agree not to take any legal action against the tattoo artist(s) or establishment (Strangeways Tattoo Company LLC) in connection with any and all damages, claims, demands, rights, and cause of action, whatever kind of nature based upon injuries, property damages, or death of myself, and of other people arising from my decision to obtain a tattoo at this time, whether caused by negligence of this establishment, or not.
    • I agree for myself, my heirs, assigns, and legal representatives to hold this establishment (Strangeways Tattoo Company, LLC) harmless to all damages, action, cause of action, claim judgment, cost of litigation, attorney fees, and all costs and expenses which may arise from my decision to obtain a tattoo at this establishment (Strangeways Tattoo Company, LLC).
    • I agree that these waivers are also to protect any business conducted at this establishment (Strangeways Tattoo Company, LLC).
    • I represent any warrant to this establishment (Strangeways Tattoo Company, LLC) that information I have given is true and correct and I have read and understood the above agreements.
    • I have been informed of possible risks and/or complications involved with the tattoo. I have requested and have been instructed on the aftercare of my tattoo as a precaution to prevent infection.
    • I understand that the tattoo(s) are permanent, and with all cuts and abrasions on the skin, there is a risk of infection.
    • I understand the removal of tattoos may leave scarring. 
    • Being of sound mind and body, I hereby release any and all persons representing this establishment of any and all legal responsibility. I agree to accept sole responsibility for any and all consequences arising from my decision to have a tattoo performed at this time & place.

    Consult a physician if signs and symptoms of infection arise, such as:

    • Fever
    • Excessive Swelling
    • Excessive Redness
    • Drainage
  • Should be Empty: