It is required by law for all tattoo shops in the Wellington Shire district to collect certain information from clients that can be provided to authorities if requested in the interest of public health.
Please read, fill out the form and agree to the terms outlined below:
(please remember to bring your drivers license or photo ID to your appointment).
I AM AT LEAST 18 YEARS OLD. I HAVE INFORMED THE TATTOOIST IF I HAVE SUGAR DIABETES. I DON’T HAVE EPILEPSY. I AM NOT A HAEMOPHILLIAC (BLEEDER). I AM NOT UNDER THE INFLUENCE OF ANY DRUGS OR ALCOHOL. I AM NOT TAKING BLOOD THINNERS OR WARFARIN / ASPIRIN.
TO MY KNOWLEDGE I DON’T HAVE ANY PHYSICAL, MENTAL, MEDICAL IMPAIRMENTS OR DISABILITIES, WHICH MAY AFFECT MY WELLBEING AS A DIRECT OR INDIRECT RESULT OF MY DECISION TO HAVE ANY TATTOO RELATED WORK DONE AT THIS TIME. I HAVE BEEN GIVEN THE AFTERCARE INFORMATION SHEET AND AGREE TO FOLLOW INSTRUCTIONS CONCERNING THE AFTERCARE OF MY TATTOO WHILST IT IS HEALING. I AGREE THAT ANY TOUCH UP WORK NEEDED DUE TO MY OWN NEGLIGENCE WILL BE DONE AT MY OWN EXPENSE.
BEING OF SOUND, MIND AND BODY, I HEREBY RELEASE ANY AND ALL PERSONS REPRESENTING TATTOO HOARDERS FROM ALL RESPONSIBILTY. I ACCEPT ANY AND ALL RESPONSIBILTY FROM ANY CONSEQUENSES THAT MAY STEM FROM MY DECISION TO HAVE ANY TATTOO RELATED WORK DONE BY TATTOO HOARDERS.
I AGREE TO NOT ISSUE LEGAL PROCEEDINGS AGAINST TATTOO HOARDERS OR ANY AGENT OR EMPLOYEE DIRECTLY, IN CONNECTION WITH ANY AND ALL DAMAGES, CLAIMS, DEMANDS, RIGHTS AND CAUSES OF WHATEVER KIND OF NATURE, BASED UPON INJURIES OR PROPERTY DAMAGE TO, OR DEATH OF MYSELF OR ANY OTHER PERSON ARISING FROM MY DECISION TO HAVE TATTOO RELATED WORK DONE AT THIS TIME, WHETHER OR NOT CAUSED BY NEGLIGENCE OF TATTOO HOARDERS.
I AGREE TO PAY FOR ANY AND ALL DAMAGES AND INJURIES TO ANY AND ALL PERSONS, INCLUDING PROPERTY BELONGING TO TATTOO HOARDERS, OR OTHER PERSONS TO WHOM TATTOO HOARDERS MAY BECOME LIABLE CONTRACTUALLY OR BY OPERATION OF LAW, CAUSED BY OR RESULTING FROM DECISION TO HAVE ANY TATTOO RELATED WORK DONE BY TATTOO HOARDERS.
I AGREE TO LEAVE THE PREMISES OF TATTOO HOARDERS, OR ANY OTHER ESTABLISHMENT WHERE TATTOO HOARDERS IS ENGAGED IN BUSINESS, PROMTLY UPON REQUEST, FOR ANY REASON WHATSOEVER, BY ANY AGENT OR EMPLOYEE OF TATTOO HOARDERS. I AGREE THAT THESE WAIVERS ALSO PERTAIN TO, AND ARE DESIGNED TO PROTECT ANY AND ALL ESTABLISHMENTS WHERE TATTOO HOARDERS CONDUCT BUSINESS. I REPRESENT AND WARRANT TO TATTOO HOARDERS THAT THE FOLLOWING INFORMATION IS TRUE AND CORRECT:
