RELEASE FORM | Top Cat Tattoos

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Tattoo Release Form

Please fill out the following form on the day of your appointment in order to get tattooed

First Name

Last Name

Date of Birth

Drivers License Customer #

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Country

I declare that the info I’ve provided is accurate & complete

Are you suffering from any heart conditions?

No

Yes

Diabetic

No

Yes

Hemophiliac

No

Yes

Have Epilepsy

No

Yes

Have you ever tested positive for HIV/AIDS?

No

Yes

Have you been diagnosed with Hepatitis?

No

Yes

Prone to seizures?

No

Yes

Diagnosed with blood disorders?

No

Yes

Are you currently taking any blood thinners?

No

Yes

FEMALES: Are you pregnant or breastfeeding?

No

Yes

If you answered yes to any question above, please elaborate

In the instance an artist injures themselves with equipment contaminated with my bodily fluid I conset to blood testing and or treatment.

If I have any condition that might affect the healing of this tattoo, I will advise my tattooer prior to the start of the tattoo.

I am not under the influence of alcohol or drugs.

I do not have medical or skin conditions such as but not limited to: acne, keloid (raised) scarring, eczema, psoriasis, large freckles or moles, or sunburn in the area to be tattooed that may interfere with said tattoo. If I have any type of infection or rash anywhere on my body, I will advise my tattooer prior to the start of the tattoo.

I acknowledge that it is not reasonably possible for the artists and employees of Top Cat Tattoos to determine whether I might have an allergic reaction to the pigments and processes used in my tattoo, and I agree to accept the risk that such a reaction is possible.

I acknowledge that infection is always possible as a result of the obtaining of a tattoo, particularly in the event that I do not take proper care of my tattoo. I agree to follow all after care instructions given to me by my tattooer while my tattoo is healing. I agree that any touch-up work needed due to my own negligence will be at my own expense.

I accept that variations in color and design may exist between the tattoo as selected by me and as ultimately applied to my body at my artist’s discretion. I understand that if my skin tone is dark, the colors may not appear as bright as they do on light skin, and that colors may appear muted once the tattoo is healed.

I understand that if I have any skin treatments, laser hair removal, plastic surgery or any other skin altering procedures, it may result in adverse changes in my tattoo.

I acknowledge that this tattoo will result in a permanent change to my physical appearance and do not hold Top Cat Tattoos or any of its employees or representatives liable for changing or removal of my tattoo once it has been obtained. To my knowledge, I do not have a physical, mental or medical impairment or disability which may affect my well being as a direct or indirect result of my decision to have a tattoo.

I waive, release and discharge the artists of Top Cat tattoos from any liability or damages.

I agree to take full responsability for checking over the SPELLING of my tattoo prior to the tattoo proceedure and release my artist of the responsibility of ensuring the correct spelling of my tattoo.

Your Signature

Email

I would like to recieve emails from Top Cat Tattoos

Top Cat Tattoos

306-244

-MEOW

(6369)

EMAIL US

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