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WAIVER, RELEASE AND CONSENT TO
TATTOO
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PLEASE READ AND BE
CERTAIN YOU UNDERSTAND THE IMPLICATIONS OF SIGNING
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THIS DOCUMENT IS TWO PAGES. PLEASE INITIAL EACH PROVISION
ON THE LINES PROVIDED AFTER READING TO SHOW THAT YOU UNDERSTAND EACH
PROVISION.
In consideration
of receiving a tattoo from _____________________________
(the “Artist”) and
Tru Blu Tatu, LLC, (and its employees, apprentices and agents, here
and after collectively referred to as
“the Tattoo
Studio”), I agree to the following:
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I, ______________________________ (clearly PRINT
your name) have been fully informed of the inherent risks, associated with
getting a tattoo. I fully understand that these risks, known and unknown,
can lead to injury, including but not limited to infection, scarring,
difficulties in detecting melanoma and allergic reactions to tattoo
pigment, latex gloves, and/or soap. Having been informed of the potential
risks associated with getting a tattoo, I still wish to proceed with the
tattoo application and I freely accept and expressly assume any and all
risks that may arise from tattooing.
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I WAIVE AND RELEASE to the fullest extent
permitted by law each of the Artist and the Tattoo Studio from all
liability whatsoever, for any and all claims or causes of action that I, my
estate, heirs, executors or assigns may have for personal injury or
otherwise, including any direct and/or consequential damages, which result
or arise from the application of my tattoo, whether caused by the
negligence or fault of either the Artist or the Tattoo Studio, or
otherwise.
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Both the Artist and the Tattoo Studio have given
me the full opportunity to ask any and all questions about the application
of my tattoo and all of my questions have been answered to my total satisfaction.
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The Artist and the Tattoo Studio have given me
instructions on the care of my tattoo while it’s healing, and I understand
them and will follow them. I acknowledge that it is possible that the
tattoo can become infected, particularly if I do not follow the
instructions given to me. If any touch-up work to the tattoo is needed due
to my own negligence, I agree that the work will be done at my own expense.
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I am not under the influence of alcohol or drugs,
and I am voluntarily submitting to be tattooed by the Artist without duress
or coercion.
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I do not have diabetes, epilepsy, hemophilia, a
heart condition, nor do I take blood thinning medication. I do not have any
other medical or skin condition that may interfere with the application or
healing of the tattoo. I am not the recipient of an organ or bone marrow
transplant or, if I am, I have taken the prescribed preventive regimen of
antibiotics that is required by my doctor in advance of any invasive
procedure such as tattooing or piercing. I am not pregnant or nursing. I do
not have a mental impairment that may affect my judgment in getting the
tattoo.
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Neither the Artist nor the Tattoo Studio is
responsible for the meaning or spelling of the symbol or text that I have
provided to them or chosen from the flash (design) sheets.
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Variations in color and design may exist between
the tattoo art I have selected and the actual tattoo when it is applied to
my body. I also understand that over time, the colors and the clarity of my
tattoo will fade due to unprotected exposure to the sun and the naturally
occurring dispersion of pigment under the skin.
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A tattoo is a permanent change to my appearance
and can only be removed by laser or surgical means, which can be
disfiguring and/or costly and which in all likelihood will not result in
the restoration of my skin to its exact appearance before being tattooed.
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I release all rights to any photographs taken of
me and the tattoo and give consent in advance to their reproduction in
print or electronic form. (If you do not initial this provision, please
advise and remind your Artist and the Tattoo Studio NOT to take any
pictures of you and your completed tattoo!).
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I agree to reimburse each of the Artist and the
Tattoo Studio for any attorneys’ fees and costs incurred in any legal
action I bring against either the Artist or the Tattoo Studio and in which
either the Artist or the Tattoo Studio is the prevailing party. I agree
that the that the courts of Pennsylvania
in Bucks County shall have
personal jurisdiction and venue over me and shall have exclusive
jurisdiction for the purpose of litigating any dispute arising out of or
related to this agreement.
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I
acknowledge that I have been given adequate opportunity to read and
understand this document, that it was not presented to me at the last
minute, and I understand that I am signing a legal contract waiving certain
rights to recover against the Artist and the Tattoo Studio.
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If any provision, section, subsection, clause or phrase of this release is
found to be unenforceable or invalid, that portion shall be severed from this
contract. The remainder of this contract will then be construed as though the
unenforceable portion had never been contained in this document.
I hereby declare that I am of legal age (and have provided valid proof of
age) and am competent to sign this Agreement.
I HAVE READ THIS AGREEMENT, I UNDERSTAND IT, I AGREE TO BE BOUND BY IT.
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Print Full Name:
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___________________________________
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Date of Birth:
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________________
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Address:
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___________________________________
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Telephone:
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________________
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Signature of Participant:
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___________________________________
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Date:
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________________
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Form
of I.D.
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________________________________
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