COVID-19 Pre-Screen and Consent Form

In light of the COVID-19 pandemic and to limit it's spread, Oak + Thistle Tattoo and Designs by Courtney Laura is implementing new policies that are to be adhered to in the shop. We ask that you read this entire form, agree to our policies and submit this before your appointment. Anyone who does not agree with our policies for health and safety or who do not comply them may potentially lose their deposit. These are extraordinary circumstances and we ask that you respect our rules so we can safely do our jobs.

Please read this form in it's entirety and truthfully fill it out.

In order to keep you safe and limit the amount of physical contact we have in the shop, here are some changes being made:

- Prior to appointments, this updated policy form must be submitted to my artist and agreed to.
- We ask that you do not arrive more than 5 minutes before your appointment. If you do, you will have to wait outside or in your car to limit exposure time within the shop.
- Your consent form will be sent to you the day of your appointment. You must fill this out in it's entirety prior to your appointment. We will no longer be handing out paper consent forms.
- Your artist may or may not choose to take your temperature at the door. If you present with a fever, you will be sent home and rescheduling will be dealt with via email.
- If you do not present with a fever, you will be handed a disposable mask. You must wear it for the duration of your appointment and we ask that you do not remove it or handle it until after you leave the shop.
- You will immediately be required to wash your hands in the bathroom or use our hand sanitizer upon entering.
- Please eat and drink before you come to your appointment. We cannot allow food or drinks in the shop anymore (sealed items are fine but must be consumed in the lobby or outside) this includes coffees and water.
- No guests will be allowed for appointments. Please only bring yourself
- Please limit the amount of personal items you bring to your appointment. No personal blankets, pillows, or excessive amounts of bags.
- If you enter the shop and it is apparent you are ill and have not been truthful on your forms, your deposit may be forfeit and you will be sent home for the day.

Have you travelled, or come into contact with anyone who has travelled by air or out of the province in the last 14 days?

YesNo

Have you had any flu-like symptoms in the last 14 days (fever, cough, shortness of breath, etc)?

YesNo

Have you come into contact with anyone who has a clinically confirmed case of COVID-19 in the last 14 days?

YesNo

Have you been ordered to self isolate, or come into contact with anyone who has been ordered to self isolate by Public Health in the last 14 days?

YesNo

I understand my temperature potentially will be taken upon arrival.

YesNo

I understand upon arrival to my appointment, I will be provided a single-use mask to wear for the duration of my time within the shop, and that I must sanitize or wash my hands immediately upon entering.

YesNo

I fully agree to adhere and be respectful to all new policies regarding health and safety while in Oak + Thistle Tattoo, and my failure to do so could forfeit my appointment.

YesNo

I affirm that, to the best of my knowledge, I am not currently sick and, in the last 30 days: have not been sick, have not been in contact with anyone that is sick, and have not traveled outside of the province.

YesNo

I understand that getting tattooed does temporarily stress the body and immune system, which could make me more susceptible to illness and infection. I accept this risk.

YesNo

I understand that Oak + Thistle Tattoo and Designs by Courtney Laura has put additional protective measures in place in order to reduce the risk of any contamination, virus, or pathogen but it is impossible to completely eliminate that risk.

YesNo

I agree to release and forever hold harmless Oak + Thistle Tattoo, its' artists and agents/representatives as well as Designs by Courtney Laura for any and all claims, damages, or legal actions in the event that I contract COVID-19 or any other illnesses after choosing to get tattooed.

YesNo

Name

First NameLast Name

Email

example@example.com

I agree that I have read this form in it's entirety and have answered all questions truthfully. By sending this form I am agreeing to the risks of getting tattooed and agreeing to do my part to keep everyone in the shop safe and healthy. **

I agree

Signature (or initials as a digital signature)*

Clear