Liability form

THE DOLOROSA TATTOO CO.
11930 Ventura Blvd, STUDIO CITY, CA 91604
1648 West Temple St, LOS ANGELES, CA 90026
RELEASE AND CONSENT FOR PERMANENT TATTOOING
PLEASE READ AND BE CERTAIN YOU UNDERSTAND THE IMPLICATIONS OF SIGNING.
PLEASE CHECK EACH PROVISION IN THE BOX PROVIDED AFTER READING TO SHOW THAT YOU UNDERSTAND EACH PROVISION.

First Name *

Last Name *

Phone Number *

Pronouns*

Email *

1. That I, (As Stated Above) have been fully informed if the inherent risks, associated with getting a tattoo. I fully understand that these risks, known and unknown, can lead to injury, including but not limited to infection, scarring difficulties in detecting melanoma and allergic reactions to pigment, latex gloves, and/or soap. Having been informed of the potential risks associated with getting a tattoo, I still wish to proceed with the tattoo application and I freel accept and expressly assume any and all risks that may arise from tattooing.2. TO WAIVE AND RELEASE to the fullest extent permitted by law each of the Artist and the Tattoo Studio from all liability whatsoever, for any and all claims or causes of action that I, my estate, heirs, executors or assigns may have for personal injury or otherwise, including any direct and/or consequential damages, which result or arise from the application of my tattoo, whether caused b the negligence or fault of either the Artist or the Tattoo Studio, or otherwise3. That both the Artist and the Tattoo Studio have given me the full opportunity to ask any and all questions about the application of my tattoo and all of my questions have been answered to my total satisfaction.4. The Artist and the Tattoo Studio have given me instructions on the care of my tattoo while it's healing, and I understand them and will follow them. I acknowledge that it is possible that the tattoo can become infected, particularly if I do not follow the instructions given to me. If any touch-up work to the tattoo is needed due to my own negligence, I agree that the work will be done at my own expense.5. I am not under the influence of alcohol or drugs, and I am voluntarily submitting to be tattooed by the Artist without duress or coercion. 6. I do not have diabetes, epilepsy, hemophilia, a heart condition nor do I take blood-thinning medication. I do not have any other medical or skin condition that may interfere with the application or healing of the tattoo. I am not the recipient of an organ or bone marrow transplant, or, if I am, I have taken the prescribed preventive regimen of anti-biotics that is required by my doctor in advance of any invasive procedure such as tattooing or piercing. I am not pregnant or nursing. I do not have mental impairment that may affect my judgment in getting the tattoo.7. Neither the Artist nor the Tattoo Studio is responsible for the meaning or spelling of the symbol or text that I have provided them or chosen from the artist.8. Variations in color and design may exist between the tattoo art I have selected and the actual tattoo when it is applied to my body. I also understand that over time, the colors and the clarity of my tattoo will fade due to unprotected exposure to the sun and the naturally occuring dispersion of pigment under the skin.9. A Tattoo is permanent change to my appearance and can only be removed by laser or surgical means, which can be disfiguring and/or costly and which in all likelihood will not result in the restoration of my skin to its exact appearance before being tattooed.10. I release all rights to any photographs taken of me and the tattoo and give consent in advance to their reproduction in print or electronic form.(If you do not check this please remind your Artist and Tattoo Studio to not take any photos of you).11. I agree to reimburse each of the Artist and the Tattoo Studio for any attorney's fees and costs incurred in any legal action I bring against either the Artist or the Tattoo Studio and in which either the Artist or the Tattoo Studio is the prevailing party. I agree to that the courts of California in Los Angeles County shall have personal jurisdiction and venue over me and shall have exclusive jurisdiction for the purpose of litigating any dispute arising out of or related to this agreement.12. I acknowledge that I have been given adequate opportunity to read and understand this document, that it was not presented to me at the last minute, and I understand that I am signing a legal contract waiving certain rights to recover against the Artist and the Tattoo Studio.13. If any provision, section, subsection, clause or phrase of this release is found to be unenforceable or invalid, that portion shall be severed from this contract. The remainder of this contract will then be construed as though the unenforceable portion had never been contained in this document. I hereby declare that I am of legal age (and have provided valid proof of age) and am competent to sign this Agreement or, if not, that my parent or legal guardian shall sign on my behalf, and that my parent or legal guardian is in complete understanding and concurrence with this agreement.14. (If you are a resident of the State of California) I agree to waive the provisions of Section 1542 of the Civil Code of the State of California which provides as follows: A GENERAL RELEASE DOES NOT EXTEND TO CLAIMS WHICH THE CREDITOR DOES NOT KNOW OR SUSPECT TO EXIST IN HIS FAVOR AT THE TIME OF EXECUTING THE RELEASE, WHICH IF KNOWN BY HIM MUST HAVE MATERIAL AFFECTED HIS SETTLEMENT WITH THE DEBTOR.
I understand that section 1542 gives me the right not to release existing claims of which I am not now aware, unless I voluntarily chose to waive this right. Having been so apprised, I nevertheless hereby voluntarily elect to, and do waive the rights described in section 1542, and elect to assume all risks for claims that now exist in my favor, known or unknown, from the subject of this Waiver and Release. I acknowledge that I have had the the opportunity to consult with legal counsel of my own choosing and to have the terms of this Waiver and Release full explained to me; that I am not executing this Waiver and Release in reliance on any promises, representations or inducements other than those contained herein; and that I am executing this Waiver and Release voluntarily, free of any duress or coercion.
What (design, etc.) :Where (location on body) :15. I agree that the procedure description of body art shown to me is correct to my specifications. I agree to immediately notify the artist in the event I feel lightheaded, dizzy and/or faint before, during or after the procedure. I understand that tattoo inks, dyes, pigments have not been approved by the federal FOOD and Drug Administration (FDA) and that the health consequences of using these products are unknown.
Medical History Questionnaire*Emergency Contact:

Please check any health conditions listed below that apply to you:

Diabetes

Fever

Blood Thinners

Scarring/Keloiding

Epilepsy

Asthma

Heart Condition

Allergic latex

Tenderness

Hemophilia

Fainting or Dizziness

Allergic to antibiotics

T.B.

Herpes

Pregnancy/Nursing

Bleeding Disorder

HBV/HIV

Skin Conditions

Eczema/Psoriasis

Other

How long has it been since you last ate?Do you have any allergies such as metals, soaps, cosmetics, or alcohol?Are you on any medication(s)?Do you have any medical or skin conditions that may affect the outcome of our procedure?Have you ever been prescribed antibiotics prior to dental or surgical procedures?Is there any other information you feel you should provide to the body art practitioner?Have you been in contact with anyone recently with Covid-19/flown on a place recently or feeling sick today?

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The information I have provided is complete and true to the best of my knowledge.
I HAVE READ THIS AGREEMENT, I UNDERSTAND IT, AND BY SUBMITTING I AGREE TO BE BOUND BY IT.

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