TATTOO WAIVER

7C-77 Lakeshore Rd West. Oakville, Ontario, L6K 1C9 (289)837-4496
THE GOLDEN PEARL

CONSENT TO APPLICATION OF TATTOO
PLEASE FILL ALL THE INFORMATION LISTED BELOW AFTER READING TO SHOW THAT YOU UNDERSTAND EACH PROVISION. FEEL FREE TO ASK ANY QUESTIONS REGARDING THIS WAIVER.
YOUR TATTOO ARTISTS NAME
YOUR NAME (FIRST AND LAST)
PHONE NUMBER
HOME ADDRESS
CITY
PROVINCE
POSTAL CODE
EMAIL ADDRESS
example@example.com
DATE OF BIRTH

Month Day Year
Date
EMERGENCY CONTACT NAME
EMERGENY CONTACT PHONE NUMBER
How did you hear about The Golden Pearl?
Answer YES or NO to the following questions
1. Do you have a fever and /or chills
2. Do you have a cough or barking cough (croup)?
3. Do you have shortness of breath?
4. Do you have a sore throat?
5. Do you have difficulty swollowing?
6. Do you have a decrease or loss of smell or taste?
7. Do you have Pink Eye?
8. Do you have a runny or stuffy/congested nose?
9. Do you have a headache?
10. Do you have digestive issues like nausea/vomiting, diarrhea, stomach pain?
11. Do you have muscle aches?
12. Do you have extreme tiredness?
13. Do you have issues with falling down often?
14. Has a doctor, healthcare provider, or public health unit told you that you should currently be isolating (staying at home)?
15. In the last 14 days, have you been identified as a "close contact" of someone who currently has COVID-19?
16. In the last 14 days, have you received a COVID Alert exposure notification on your cell phone?
17. In the last 14 days, have you travelled outside of Canada?
18. Are you pregnant?
19. Are you breastfeeding?
20. Are you under the influence of drugs or alcohol?
21. Do you understand that a tattoo is permanent and there are no refunds?
22. Do you understand that color tattoos may vary depending on skin type?
21. Do you have any allergies? If YES, please list allergies:
22. I fully understand that complications may occur, such as infection/allergic reactions.
23. Do you have any medical conditions or bleeding disorders? (example: Diabetes) If YES, please list:
24. Do you have HIV, AIDS, Hepatitis or any other communicable disease?
25. Do you understand that each artist has a unique style and will not copy somebody else's work therefore your tattoo will not be identical to the reference photos you supplied?
26. Are you aware that tattoos do not heal or hold well on hands, fingers, elbows, knees and feet and therefore we do not offer a free touch up in those areas?
27. Do you have any physical, mental, medical impairment or disability which might affect my well-being as a direct or indirect result of my decision to have a tattoo done at this time?
28. I agree to follow the aftercare instructions given to me.
29. I have reviewed and approved the design/spelling/stencil/placement that the artist has completed for me prior to the tattoo application.
30. I understand that The Golden Pearl and my Tattoo Artist reserves all rights to use any photos of my tattoo done at The Golden Pearl.
31. I have answered all of the above questions truthfully.
I WAIVE AND RELEASE to the fullest extent permitted by law each of the artists at The Golden Pearl 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 otherwise, including or otherwise, including any direct and/or consequential damages, which result or arise from the procedure and application of my tattoo, whether caused by the negligence or fault of either the artist or The Golden Pearl Tattoo Studio, or otherwise.
I acknowledge that by signing this waiver, I have been given the full opportunity to ask any questions which I might have obtaining a tattoo from The Golden Pearl. I agree with the terms and conditions and that my questions have been answered to my satisfaction.
Signature:

Clear
Date:

Month Day Year
Date
Proof of Identification (i.e. Drivers license, bring with you to your appointment):
THIS SECTION IS FOR CLIENTS UNDER THE AGE OF 18
Name of parent approving tattoo for minor:
Parent Date of birth:
Proof of Identification (i.e. Drivers license, bring with you to appointment):
I give the artist permission to perform a tattoo procedure on (minor's name) and take full responsibility from any issues that may arise.
Parent Signature:

Clear
Minors Signature:

Clear
DON’T FORGET TO CHECK INTO THE GOLDEN PEARL TATTOO ON FACEBOOK

FOLLOW US ON INSTAGRAM!!! @THEGOLDENPEARLTATTOO
Should be Empty:

THE GOLDEN PEARL

THIS SECTION IS FOR CLIENTS UNDER THE AGE OF 18