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I oil% LUCK TAT*- 00 Tattoo Agreement and Release from Liability I. (print your name) understand and acknowledge that there are risks associated with the act of tattooing. These risks include, but are not limited to, infection, allergic reactions to pigments and ointments, transmission of illness/diseases/viruses, variations in color and design. I understand and accept these risks. I also understand that a tattoo is a permanent alteration of my body. hereby state that, to the best of my knowledge, I have no physical, mental, and/or medical impairments or disabilities that would impair my decision making process. 1 hereby affirm, represent, and acknowledge that I am not under the influence of any drug and/or alcohol that would negatively influence my decision making in the tattoo process. agree and acknowledge that it is unreasonable for any owner, artist, or agent to know that I am allergic to any pigments or processes involved in tattooing. I also agree to follow any aftercare given to me as a guideline only and not to be taken as medical advice. I hereby accept all responsibility for my actions and decision to receive a tattoo from Hard Luck Tattoo. I agree to not sue Hard Luck Tattoo, the owners of said property, or any contractor or agent associated with Hard Luck Tattoo. I hereby release and discharge any artist residing at Hard Luck Tattoo from and against any and all claims due to damage to the clients clothing, body, or reputation, directly or indirectly stemming from the tattoo process. I fully understand and declare that, if the facts concerning the claims released herein are found to be different from those now believed to be true, I assume the risk of such differences fact and agree that this"release from liability" shall be and will remain effective notwithstanding such difference in fact. I agree that I have read this "Release from Liability" in its entirety and enter into this agreement to pay for services rendered at the time of service, and to respect the most personal of all art forms by following the suggested care instructions, voluntarily and with full understanding thereof, and of the rights and obligations affected by its terms, hereby execute this"Release of Liability." (initials) I have read the above and agree fully. Client's Name Phone Number ( ) Address City Zip Date of Birth / / Age ID #:(STATE / MILITARY/PASSPORT) Please print your e-mail if you would like notifications from us (specials, discounts. Guest Artists. etc.) Tattooer Tattoo Image Price Words to be Tattooed (will be done exactly as written) Are You Pregnant and/or Nursing? If Yes, STOP!!!!!! Come back when you are not.... end of discussion Have you eaten in the past 4 hours? Y / N Are you Diabetic? Y / N What type? Are you taking blood thinners and/or Antabuse? Y/ N Do you have a latex allergy? Y / N Do you have any contagious diseases? Or history of IV drug use? (Please, Please be honest. For the safety of all. This will remain confidential) Are you currently free from intoxication from illicit drugs and/or alcohol? Y / N Are you under the care of a physician or have any current and/or past medical conditions that may affect the tattoo application or healing? Signature of Client Date / /20 Can I take and use a photograph of your tattoo in any way I see fit? Y / N