Tattoo Release of Liability

Release of Liability Form

Lucid Arts Tattoo

* Indicates required field

Name *

First

Last

Phone Number *

Email *

Pronouns *

Date of Birth (mm/dd/yyyy) *

Tattooist *

Address *

I have requested that tattoo work by done on my body and in order to induce you to agree to do this to me, I make the following representations:

I am of sound body, mind and understanding
I am at least 18 years of age
I am not under the influence of drugs or alcohol
I am not on antibiotics and am not planning to be on antibiotics for any scheduled dental or medical procedure
I am not a hemophiliac
I do not have high blood sugar
I do not have a heart condition
I am not HIV positive
I do not have Acquired Immune Deficiency Syndrome (AIDS)
I do not have Hepatitis
I am not pregnant
I am not epileptic
I have not had joint-replacement surgery (rendering me more susceptible to allergic reaction)
I understand that tattoos are permanent
I understand that, although rare, tattoo inks may cause mild to severe allergic and other reactions, including, but not limited to, infection, anaphylaxis, skin cancer, flare up of psoriasis or other skin diseases, keloids (scar tissue), photosensitivity, redness, rash, bumps, swelling, blisters, loss of skin color, scaly raised skin, MRI burn, pain, dizziness, fainting, nausea, and swollen or infected lymph nodes. I understand that ink allergies may develop immediately, or up to years after a tattoo.

I have been informed of the nature, risks, and possible complications and consequences of permanent skin pigmentation. I understand that the permanent skin pigmentation procedure carries with it known and unknown complications and consequences associated with this type of procedure. I understand that the color of the pigment may be modified slightly, due to the tone and color of my skin. I understand that tattoo inks are subject to change as they age, including fading, feathering out, dissipating, color changes and loss of pigment, and loss of sharpness. I fully understand this tattoo process and therefore understand that it is not an exact science, but an art. I request the permanent skin pigmentation procedure(s), and accept the permanence of the procedure as well as the possible complications and consequences of said procedure(s).

Initial *

I understand that if I have any skin treatments, laser hair removal, plastic surgery or other skin altering procedures, it may result in adverse changes to my tattoo. I acknowledge some of these adverse changes may not be correctable.

Initial *

I have received pre and post procedure instructions and I will strictly adhere to such instructions. I understand that my failure to do so may jeopardize my chances for a successful procedure. If I am on any medication for depression or any other mood altering prescription, I will advise my technician.

Initial *

I understand that the taking of photographs of the said procedure(s) are a condition of the procedure(s)

Initial *

I certify that I have read and initialed the above paragraphs and have explained to my understanding this consent and procedure permit. I accept full responsibility for the decision to have this tattoo work done.

Initial *

I fully understand this release form and represent that all information is true under penalty of law.

Initial *

In consideration of you agreeing to do the tattoo work I have requested, I agree not to sue Lucid Arts and/or any of its officer, directors, shareholders, employees, subcontractors, suppliers, associates, or sub tenants (all of whom are hereafter collectively referred to as “Lucid Arts”) and/or any other party who may claim to contribution or indemnity from or against Lucid Arts in connection with any injury, damages, claims or disability I may suffer as a result of the tattoo work done as consequence hereof, whether or not cause by any negligence by any member of Lucid Arts.
And I hereby, for myself, my heirs, administrators, executors and assigns, remise, release and forever discharge the members of Lucid Arts of and from all manners of action, claims, losses and demands of every nature and kind whatsoever, both in tort and contract, which I and/or my heirs, executors, administrators, or assigns may have for or by any reason of injury, illness, or disability which I may suffer as a result of the tattoo work I have requested.
I have read and understood all of the foregoing.

By signing below, the Client agrees to use a typed signature for above agreement with Lucid Arts Tattoo + Design.
*If the client prefers to hand-write this agreement, the client is responsible for requesting a paper Release of Liability Form.

Date *

Client Signature *

If you are under the age of 18 years old you must have a parent or guardians consent for the procedure to take place:

DATE *

Guardian Signature *

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Release of Liability Form

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