Waiver/Release Form

Blackwater Electric Tattoo

Whippletree Junction, Duncan

4705 Trans Canada Highway, Duncan

First name

Last name

Pronouns

Phone

Todays date

Address

Instagram Handle

Emergency contact name and phone #

Artist

If you are being tattooed by a guest artist

leave blank if not applicable

Artist name

Artist Email

Please check the boxes

1. I have eaten in the last two hours.

2. I am at least 18 years old and have valid photo ID.

3. I agree to follow the proper healing instructions provided by my artist, including avoiding swimming or

any conditions that may compromise healing within an agreed term.

4. I consent to the use of Bactine and/or other lidocaine products during my session and confirm I have

not had a previous reaction to lidocaine. If I have experienced a reaction or prefer not to use it, I will

inform my artist to avoid using lidocaine products.

5. I agree to pay in full for my session (using E-transfer or cash) immediately after the session less terms

of deposit.

6. I confirm that I am not currently sick with any viral infection or contagious illness/ disease - disclosure

of known illness, virus, or contagion is mandatory for your safety and the safety of others including staff

and other clients.

7. I understand that tattoos are permanent, and that any movement, flinching, or tensing during my

session may affect the tattoo.

8. I acknowledge that UV exposure will fade my tattoo over time.

9. I understand that, while unlikely, it is possible to have a reaction to inks, and that tattoo healing may

temporarily affect my immune system.

10. I acknowledge that this shop and my artist adhere to the highest standards of sterility and cross-

contamination prevention.

11. I consent to having a photo of my tattoo taken and authorize its use for marketing, portfolios, and

other promotional materials.

12. I understand and accept the design and payment terms and acknowledge that preliminary drawings

may differ from the final tattoo.

13. I acknowledge that bruising and swelling may temporarily affect the appearance of my tattoo until it

is fully healed.

14. I understand that tattooing carries inherent risks, including possible impacts on my health, and

assume all responsibility for those risks.

15. I confirm that I have no diseases, conditions, or other health concerns (including pregnancy) that

would compromise healing or present additional health risks from being tattooed.

16. I am aware that I may experience temporary impairment after a longer session and can arrange a

safe transportation home via taxi, Uber, or a friend (recommended). I accept all liability for my safe

passage home.

17. I understand that tattooing is an art form on a biological canvas and that factors outside the control

of the artist or studio may affect the result.

18. I assume all responsibility for following proper healing protocols throughout my sessions and

understand that improper care may result in color loss, scarring, adverse reactions, and irreversible

damage to my tattoo and skin.

19. I am of sound mind and body and hereby consent to receive a tattoo, releasing any claims against my

tattoo artist and the studio. I will not seek refunds for any procedures performed by this artist or studio.

20. Photo and Video Consent and Social Media Release:

• I consent to the recording of video and/or photographs of my tattoo session, from the start to the

completion of the appointment, including any preparatory work, tattooing process, and aftercare

instructions.

• I authorize the artist and studio to use any images or videos taken during my session for promotional

purposes, including social media platforms, websites, portfolios, and marketing materials.

• I waive any right to review or approve the use of photos or videos and understand that these materials

may be used indefinitely.

• I acknowledge that I will not receive any financial compensation for the use of these images or

recordings.

• I will agree not to photograph or video document the process of tattooing without informed consent of

the artist.

• I agree that I will not photograph or video document anyone else receiving tattoo work or working

within the shop area without explicit informed consent.

21. Assumption of Risk:

I understand that there are potential risks associated with tattooing and the sharing of media related to

the session. I assume all responsibility for any risks to my tattoo and release all individuals and entities

involved from any liability for claims arising from these procedures. By signing this document, I

acknowledge that I have read, understood, and agreed to the terms outlined above, including consent to

video and photo recording and social media sharing.

Signature

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