CONSENT TO APPLICATION OF TATTOO

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

CONSENT TO APPLICATION OF TATTOO
THIS DOCUMENT IS TWO-SIDED. 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.
TATTOO ARTIST NAME
NAME (FIRST AND LAST)
PHONE NUMBER
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. Have you travelled outside of Canada?
2. Do you have a cough or fever?
3. Have you worked in facilities or been in contact with COVID 19?
4. Are you pregnant?
5. Are you breastfeeding?
6. Are you under the influence of drugs or alcohol?
7. Do you understand that a tattoo is permanent and there are no refunds?
8. I realize that color tattoos may vary depending on skin type?
9. Do you have any allergies? If YES, please list allergies:
10. Do you have any medical conditions or bleeding disorders? (example: Diabetes) If YES, please list:
11. Do you have HIV, AIDS, Hepatitis or any other communicable disease?
12. I agree to follow the aftercare instructions given to me.
13. I fully understand that complications may occur, such as infection/allergic reactions.
14. 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 (Your Name) :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:
THIS SECTION IS FOR CLIENTS UNDER THE AGE OF 15 AND OVER THE AGE OF 15
Name of parent approving tattoo for minor:
I give the artist permission to perform a tattoo procedure on (minor's name):
Parent Signature:

Clear
Minors Signature:

Clear
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Should be Empty:

THE GOLDEN PEARL

THIS SECTION IS FOR CLIENTS UNDER THE AGE OF 15 AND OVER THE AGE OF 15