Waiver

First Name

Last Name

Please Upload Photo of ID (If Minor, SKIP)

Are you a Minor?

YES - I am 18 or Under. My parent/guardian will fill out the rest of this page NO - I can skip this page

Parent's Full Name

Relationship

Upload Guardian ID

Brief Description of Tattoo

Placement of Tattoo?

I understand the touch-up policy

I understand the touch-up policy for tattoos in high friction/flexion areas such as the hand, foot, knee, elbow or neck, and I agree to additional charges for touch-ups for these areas.

Yes, I am 100% satisfied withe design and confirm it to be tattooed on me.

I have reviewed the tattoo design with the artist and wil proceed with said design. I agree that this deisgn cannot be modified and is permanent.

Have you been tattooed at La Black Mamba Studio before

Yes No

Emergency Contact Name

Contact Number

At this moment I am not pregnant

I agree

I have mentioned any skin conditions or disorders to my artist

I agree

I have not had any surgery in the past month, I do not have an upcoming surgery this month, and I am not recovering from any injuries in the place of my tattoo

I agree

I have spoken to my artist about any conditions I have: heart condition, seizures, diabetes, liver/blood/skin disorders, hepatitis, HIV or AIDS

I agree

I have eaten with the last 2-4 hrs. I understand that tattooing on an empty stomach may cause me to feel faint, nauseous or dizzy

I agree

Allergic to Numbing Agents - I will let me artist know about my allergies to lidocaine, prilocaine or similar ingredients found in numbing cream.

I agree

Please list any other medical conditions, allergies or medications. La Black Mamba studio is not legally responsible for any medical issues arising from inaccurate or incomplete information provedein this section.

By ACCEPTING this waiver, I certify the following:

The identification document I provided and the information contained in this form is accurate and correct. All my questions and concerns have been fully addressed, and I am 19 years of age or older (or present with my parent/legal guardian). I understand and accept full responsibility for the aftercare of my tattoo. I acknowledge the risk of allergic reactions or infections due to improper aftercare or hygiene, and I agree to follow all aftercare instructions provided by La Black Mamba Studio. I also understand that these instructions are not a substitute for medical advice. I understand that I may feel lightheaded, dizzy, or faint during the tattoo process. I acknowledge the permanency of the tattoo and understand the procedures and costs involved in removing or altering it in the future. I hereby release La Black Mamba Studio and its employees from any liability, and I waive my right to pursue litigation resulting from my decision to get a tattoo or from improper aftercare. I confirm that all equipment used in my tattoo will be sterile, and I am satisfied with La Black Mamba Studio's adherence to health, safety, and cross-contamination guidelines as required by the province of British Columbia. I understand that La Black Mamba Studio maintains a strict no-refund policy. I grant permission for photographs and videos of my tattoo and the tattooing process to be used for marketing and promotional purposes. (If you do not wish for your photo to be used, please notify the front desk immediately.)

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