Fillable Printable Tattoo Liabilty Waiver Form - Florida

Tattoo Liabilty Waiver Form - Florida

TATTOO RECORD & RELEASE FORM

I, the undersigned, agree of my own free will to the performance of the above procedure by

Bad to the Bone Tattooing.

DATE: ______/________/_______.

The procedure has been explained to me along with its inh

erent risks.

I understand an

agree to hold harmless and release from liability Bad to the Bone Tattooing and it's staff and

employee's for any event, after

effect, or consequence arising from the above procedure. If all

questions have been answered please

initial.____________

An after

care regiment has been explained to me at the time of the procedure and I agree to

follow it as recommended.

I understand an agree to hold harmless and released from liability

Bad to the Bone Tattooing and it's staff

and employee's for any event, after

effect or

consequence arising from the above procedure. If you understand and agree please

initial.____________

Minors: Anyone under the age of 18 must have a notarized form from a parent or legal

guardian.

one under the age of 16 will be tattooed.

NAME:______________________________

AGE:________ DOB: ______/_______/______

ADDRESS:____________________________ CITY:__________ STATE:______ ZIP:_______

PHONE:__________________ SEX: M_____

F_____

RACE: WH_____

BLK_____ HSP____

ASIAN_____

OTHER_____

ANY ALLERGIES TO:

Bacitracin, Bag Balm, Isopropyl Alcohol, Benzocaine, Lyidocaine, Green

Soap, Any Type Of Ink Or Dye,

other:_______________.

IN CASE OF EMERGENCY PLEASE CONTACT: _____________________

_______________

ADDRESS/PHONE:_____________________________________________________________

SIGNATURE:_______________________________

TATTOO PERFORMED BY:_________________ TYPE OF TATTO

O:____________________

PRICE OF TATTOO:________________________ LOCATION:_________________________

CONDITION OF SKIN AT TATTOO SITE: _________________________________________

NOTARY IF NEEDED

NAME OF MINOR:_______________ PARENT OR GUARDIAN:______________

_________

THIS SIGNATURE NOTARIZED BEFORE ME ON THIS DATE:_______/_______/________

NOTARY SIGNATURE:________________________

PRINTED NAME: _____________________________

(SEAL)

ANY COMPLICATIONS DURING PROCEDURE:_____________________

____________

___