Fox Runner Client Waiver. Brent

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E‑mail *

Legal name

Preferred name (if applicable)

Pronouns *

He/Him

She/Her

They/Them

Jiné:

Povinné

Phone number *

Home address *

Do you have any medical conditions that may affect your tattoo procedure? If yes please list.
*

Do you have a latex allergy. *

Yes

Please list medications you are taking *

Please read through and check each box to confirm the following:

I affirm that I am free of diabetes, epilepsy, hepatitis, hemophilia, HIV-AIDS or any other communicable disease, heart condition or take medicine which thins the blood. I am not pregnant or nursing. I am not under the influence of alcohol or drugs. I understand that failure to disclose this information will hold me liable. Please initial for this section.

I do not have medical or skin conditions such as but not limited to: acne, scarring (Keloid) eczema, psoriasis, freckles, moles or sunburn in the area to be tattooed that may interfere with said tattoo.

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

I realize that variations in colour and design may exist between any tattoo as selected by me and as ultimately applied to my body. I understand that if my skin colour is dark, the colours will not appear as bright as they do on light skin.

I understand my deposit is non-refundable. If I need to cancel or change my appointment I will give a minimum of 48 hours notice. Failure to provide notice will result in forfeit of my entire deposit.

I release the rights of all photographs of myself and tattoo taken at Fox Runner Tattoo and fully consent to their reproduction in print or electronic form.

I agree the final approval of spelling, design and placement of my tattoo before the procedure begins is solely my responsibility and will not hold Fox Runner Tattoo Inc. or any of its representatives liable.

I acknowledge I am over the age of eighteen. I consent to the application of the tattoo and willingly submit to its procedure. I hereby state that all information provided by me and all questions answered/initialed by me on this form is true and correct.

I willingly agree to and hereby release, forever discharge and hold harmless Fox Runner Tattoo Inc. and any of it’s representatives from all liabilities and/or claims connected to any damages, financial/property losses, legal actions, and personal injuries including but not limited to infection, allergic reactions, ink rejection, and death arising as a result of my tattoo and any procedures and instruments used to apply my tattoo.

Povinné

Clients full legal name, providing your name below acts as a virtual signature and indicates that you agree to the terms outlined above.
*

Completed and signed on
*

RRRR

Artist you are seeing
*

*for artist use only.

Disposable batch numbers and info.

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