Release Form for Artist Victoria Select a different artist Your InfoYour Name(Required) First Last Nickname or Preferred Name First Pronouns Your Phone(Required)Your Email Address(Required) Email Address Confirm Email Address Your Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Waive and ReleaseRisks(Required)I have been fully informed of 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 tattoo pigment, latex gloves, bandaging, and/or soap or aftercare. Having been informed of the potential risks associated with getting a tattoo, I still wish to proceed with the tattoo application, and I freely accept and expressly assume any and all risks that may arise from tattooing. I agreeWaive and Release(Required)I WAIVE AND RELEASE to the fullest extent permitted by law each of the artists and the facility they're employed/contracted by 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 by the negligence or fault of either the artist or the facility they're employed/contracted by, myself, or otherwise. I agreeQuestions(Required)Both the artist and the facility they're employed/contracted by 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. I agreeHealing(Required)The artist and the facility they're employed/contracted by have given me instructions on caring for my tattoo while it’s healing, and I understand and will follow them. I acknowledge that it is possible that the tattoo can become infected, particularly if I do not follow the instructions. 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. I agreeSober Consent(Required)I am not under the influence of alcohol or drugs, and I voluntarily submit to being tattooed by the artist without duress or coercion. I agreeHealth(Required)I do not have diabetes, epilepsy, hemophilia, or 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 antibiotics 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 a mental impairment that may affect my judgment in getting the tattoo. I agreeHealth ContinuedPlease let us know if there's anything that may impact your healing such as being diabetic or taking blood-thinning medication. Meaning/Spelling(Required)Neither the artist nor the facility they're employed/contracted by is responsible for the meaning or spelling of the symbol or text that I have provided to them or chosen from the flash (design) sheets. I agreeVariations(Required)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 occurring dispersion of pigment under the skin. I agreePermanent Change(Required)A tattoo is a 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. I agreePhotos(Required)I agree to let the artist and facility they're employed/contracted by use photographs of me or my tattoo for portfolio or advertising purposes. I agreeInstagram HandleIf you'd like us to tag you in instagram photos Understand(Required)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 facility they're employed/contracted by. I agreeLegal Age(Required)I hereby declare that I am of legal age (and have provided valid proof of age) and am competent to sign this Agreement. I understand parental consent does not apply to tattoo contracts or procedures in Oregon. I agreeYour AppointmentDate of appointment(Required) MM slash DD slash YYYY Time of Appointment(Required) Hours : Minutes AM PM AM/PM Description of tattoo Placement on body Submit a photo of your ID(Required)Max. file size: 300 MB.Type your name here to sign this document(Required) EmailThis field is for validation purposes and should be left unchanged. Δ