Release Form - Elite Ink Tattoos

Comments

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CLIENT PORTION - Contact Information

Passport or State Issued ID(Required)

Accepted file types: jpg, png, jpeg, gif, pdf, heic, Max. file size: 15 MB.

Please upload a current photo of your Driver's License, State ID, or Passport for age verification.

Drag with one finger to position. Pinch to zoom. Twist to rotate. Align inside the white frame, then tap Use Photo.

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Name(Required)

Address(Required)

Phone(Required)

Email(Required)

Emergency Contact Information

Name(Required)

Phone(Required)

Relation to Client(Required)

Address(Required)

Questionnaire

Do you have any existing condition(s) that could affect the healing process such as allergies to medications, tattoo dyes or inks, latex, or medications such as anticoagulants that thin the blood and/or interfere with blood clotting?(Required)

Yes

If yes, please explain(Required)

I understand that in the event of an adverse reaction or unexpected event/emergency, actions taken will vary on the situation and could lead up to and include calling Emergency Medical Services.(Required)

Yes

Are you currently intoxicated or under the influence of any drug(s) or alcohol?(Required)

Yes

Are you pregnant?(Required)

Yes

Are you breastfeeding?(Required)

Yes

Have you eaten within the last four (4) hours?(Required)

Yes

Are you prone to fainting?(Required)

Yes

I have read and understand the Grievance Complaint Sign.(Required)

Yes

I understand that I cannot donate blood for the next 12 months.(Required)

Yes

Agreement

To induce ELITE INK TATTOOS to TATTOO my...(Required)

, and in consideration of doing so, I hereby release ELITE INK TATTOOS, it's employees and agents from all manner of liabilities, claims, actions and demands in law or equity, which I or my heirs have or might have now or hereafter by reason of complying with my request to be tattooed. I FULLY UNDERSTAND THAT ANY EMPLOYEE OR AGENT SUGGESTIONS MADE BY ANY EMPLOYEE OR AGENT ARE JUST SUGGESTIONS. They are not to be construed as or substituted for advice from a medical professional. I UNDERSTAND that I will be tattooed with appropriate instruments and techniques. To ensure proper healing of the tattoo, I AGREE to follow the aftercare procedures outlined in the "Aftercare" instruction sheet, until healing is complete. BY MY SIGNATURE BELOW, I certify that I willingly submit to these procedures with full understanding of possible complications such as, but not limited to, infection and/or allergic reaction to the pigment of the tattoo. I understand that by having this tattoo performed, I am making a permanent change to my body and no claims have been made regarding the ability to undo changes made.

Client Signature(Required)

Tattoo Release Form

CLIENT PORTION - Contact Information

Emergency Contact Information

Questionnaire

Agreement

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Please click on the link below to visit Elite Body Piercing

LOCATED ONLY A HALF MILE AWAY

DUE TO SOUTH CAROLINA STATE GUIDELINES, TATTOOS AND PIERCINGS CANNOT BE DONE WITHIN THE SAME FACILITY