Tattoo Release Form

Tattoo Release Form
Take a picture of your ID*

Name*
First NameLast Name
Email*
example@example.com
Address*
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Drivers Licence #*
Date Of Birth*
MonthDayYear
Date

Read and Check All The Boxes*
I am not pregnantI am free of Communicable DiseasesI have truthfully represented to the associates, agents, representatives of Topper's that I am eighteen (18) years of age or older, have no guardian or committee appointed for me by any court anywhere and am competent and make this releaseI understand that it is not reasonably possible for the associates, agents, representatives of Topper's to determine whether I might have any allergic reaction to aftercare ointment or the processes used in the tattoo; and I voluntarily assume and accept all risks that such reactions are possible.I understand that infection is possible as a result of a tattoo, particularly in the event that I fail to take proper care of my tattooI will receive written instructions advising me of the proper care of my tattoo and I recognize the necessity for following these instructionsI understand that a tattoo is a permanent change to my body and appearance and no representation has been made that once made, any tattoo can be altered or removedMy tattoo is by my choice alone, and I have not been influenced in anyway by Topper's to obtain a tattoo. I consent to the application of my tattoo, and procedures necessary to perform the tattoo.I consent to the application of my tattoo, and procedures necessary to perform the tattoo.I release, forever discharge, and hold harmless Topper's and its apprentices, associates, agents, offers and owners, from and against any and all claims, damages, and/or legal procedures actions arising from or in anyway connected to my tattoo and/or by which my tattoo is applied.I understand that there are risks involved in the application of a tattoo and there are NO REFUNDS once a tattoo has been paidI covenant and declare that I am not intoxicated or under the influence of drugs or alcohol.I do not have epilepsyI covenant that Topper's may refuse to perform my tattoo at Topper's sole discretion.I do not have any medical problems which in any way affect or might affect my tattoo. If I do, I have entered them in the box below.
Enter any medical problems which in any way affect or might affect my tattoo

Signature*
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