Standard Release Form

I am at least 18 years old. I don't have a heart condition. I don't have epilepsy. I haven't had hepatitis within the last year. I'm not a hemophiliac (bleeder). I'm not under the influence of drugs or alcohol.

To my knowledge, I don't have any physical, mental, or medical impairment or disability which might affect my well-being as a direct or indirect result of my decision to have any tattoo-related work done at this time.

I agree to follow all instructions concerning the care of my tattoo while it is healing. I agree that any touch-up work needed, due to my own negligence, will be done at my own expense. I understand that if my skin color is dark, the colors will not appear as bright as they do on light skin. Being of sound mind and body, I hereby release any and all persons representing

--- (also known as_) from all responsibility. I accept any and all responsibility myself for any consequences that might stem from my decision to have any tattoo-related work done by_

I agree not to sue_in connection with any and all damages, claims, demands, rights, and causes of action of whatever kind or nature, based upon injuries or property damage to, or death of myself or any other persons arising from mv decision to have tattoo-related work done at this time, whether or not caused by any negligence of_

I agree for myself, my heirs, assigns; and legal representatives to hold_

harmless from all damages, actions, causes of action, claim judgements, costs of litigation, attorney's fees, and all other costs and expenses which might arise from my decision to have any tattoo-related work done by___

I agree to pay for any and all damages and injuries to any and all persons and property belonging to__ or any other person to whom_

may become liable contractually or by operation of law, caused by, or resulting from my decision to have any tattoo-related work done by_

I agree to leave the premises of_i or any other establishment where_is engaged in business, promptly upon request, for any reason whatsoever, by any agent or employee of_

I agree that these waivers also pertain to and are designed to protect any and all establishments where_conducts business.

I represent and warrant to_that the following information is true and correct

Please Print

Last First Initial Age Date

Address:__

Street City State Zip Phone

I have read and understood each of the above paragraphs.

Thttoo:_

Signature:_

Location:_

All rights reserved © Reprinting illegal without written consent from Spaulding & Rogers Mfg., Inc.

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