Tattoos By The Bay
RELEASE/HOLD HARMLESS AGREEMENT DATE:_________
I hereby release Tattoos By The Bay and affiliated companies and artists from all manner of actions, causes and demands in law or in equity which I or my heirs, executors or administrators have or might have now or hereafter by reason of their complying with my request to tattoo or pierce my body. I understand that all instruments to be used were properly sterilized and proof of such sterilization was provided to me. I understand that proper hygiene and aftercare is required to prevent infection and some individuals may be sensitive to some pigments. In addition, I am not under the influence of any intoxicating substance or suffering from AIDS, Hepatitis, Tuberculosis, or any other infectious diseases and have not tested positive for HIV. I acknowledge receipt of oral or written instruction on the proper care of my tattoo or piercing. I am aware that if the identification I supply is a forged document, Tattoos By The Bay will in no way be liable.
Name: _____________________ Address: _________________________
City: _____________________ State: ____ Zip Code: _____________
Driver’s License or State I.D. # ________________ Date of Birth _______
Signature: ____________________________________________
Guardian I.D. # __________________ Signature: ___________________
(For Piercing only – must be 18 years of age to be tattooed)
Design: ________________ Location: ______________ Artist: ________
Piercing: __________ Jewelry Size: ________________
In order to promote healing of the body art preformed, we ask that you disclose if you have, or have had any of the following conditions that may affect healing process:
Yes __ No__ Diabetes
Yes __ No __ History of hemophilia (bleeding)
Yes __ No__ Skin Diseases, lesions, or sensitivities to soap, disinfectants, ect.
Yes __ No__ Skin Allergies or adverse reactions to pigments, dyes, or inks
Yes __ No__ History of epilepsy, seizures, fainting, or narcolepsy
Yes __ No__ Pregnancy or breast - feeding / nursing
Yes __ No__ Immune disorders
Yes __ No__ Scarring (keloid)
Colors Used: Black / White / Red / Orange / Yellow / Green / Blue / Purple / Pink / Brown
Placement of Tattoo or Body Piercing ____________________________________________
PLACE I.D. HERE TO
COPY