Waiver

for laser tattoo removal waiver click here! 

Due to recent cold/flu/ covid outbreaks – if you are symptomatic you will be requested to wear a mask- regardless of vaccination status. you must come alone to your tattoo appointment- hand sanitizer must be applied once you arrive, masks must be worn at all times, if you require a snack or drink while we are working a break will be taken to accommodate you.

i will also be wearing a disposable apron, protective sleeves, protective eyewear and a mask as well.

and medical grade disinfectant is used on all surfaces prior to your appointment. 
if you are going to be late- please contact me right away, being late -even just 15 minutes might interfere with my schedule which is planned to the minute to accommodate all the extra cleaning, breaks, etc.. being 15 minutes late would greatly affect this and could result in rescheduling entirely. Being late without contact would result in forfeit of deposit. 

my address is 115 Rands road Ajax – Harwood and westney are closest intersections

your service provider is Christine fenzl

Reminder for your appointment today! Please check ✔️ That your aware of the following *

• My appointment is today!—— please be sure to fill out the form entirely 1-2 hours prior to arrival. If you fill this out early- you will be asked to fill out again when you arrive😣
• I do not have any CUTS, SCRATCHS, BUG BITES, RASH, ABRAISIONS OF ANY KIND , OR BURNS WITHIN 6 INCHES OF THE TATTOO AREA -? PLEASE CHECK NOW BEFORE YOU GO ANY FURTHER WITH THIS WAIVER – WE CAN NOT TATTOO WITH ANY OF THESE SKIN CONDITIONS NO MATTER HOW MINOR!
• I have eaten today! You must eat 1-3 hours prior to arrival of your tattoo I understand I can not be fasting or dieting the day of my procedure and the impact they have on my tattoo proceeded. Should your artist feel you have not prepared adequately you could be asked to reschedule for another time. Failure to eat properly could result in low sugar (hypoglycaemic episode) you could pass out and we will need to stop the tattoo at that time. Even if the tattoo is incomplete.
• I have a snack and a sugary drink to bring in with me (Not water or sugar free! This is for recovery if you feel faint)
• No alcohol or drug use 24hr before coming – includes marijuana. Limit your caffine and advil intake as this will cause excessive bleeding and bruising and could affect the outcome of your tattoo

GENERAL pre-screening – please check if any apply to you its easier for me to reschedule you- than risk myself becoming i’ll and having to reschedule many people- so please answer truthfully- any of these we will need to reschedule your apt. *

• Cough
• Fever -higher than 37.8 C or 100F
• Shortness of breath-that are not known for any other health issue you may have
• Sore throat-not related to allergies or other medical conditions you normally have
• Difficulty swallowing
• Runny or stuffy nose
• Decrease or loss of taste or smell
• Nausea,vomiting, diarrhea, stomach pain
• Pink eye
• Unusual headache if your not prone.
• Muscle spasms
• Extreme fatigue/tiredness
• a dr or health care provider told you that you should be isolating?
• You have travelled outside of Canada in the last 14 days?
• You have a sunburn, cut, rash within a handsize around the tattoo area- we will need to reschedule
• you have been identified as been in contact with someone who currently has covid-19
• You have any medical conditions that could affect the tattoo proceedure or healing of your tattoo
• you have been vaccined within the last 14 days or going to have vaccine within 14 days this applies. As the vaccine greatly impacts your immune system and could affect healing time.
• I’m currently taking antibiotics – or finished within the last 14 days
• I have had or will have a surgical procedure within 4 weeks before or after this apt- it’s not recommended to get the tattoo if this is the case- it may impact healing of surgical procedure or your tattoo
• None of the above

We request if you are feeling unwell – even if you think it might just be a cold- to please reschedule your tattoo apt. For the safety of our artists, staff and others who may be attending our facility.

Name *

First

Last

Phone *

Email *

Email

Confirm Email

If under 18, please upload government photo id,

Click or drag files to this area to upload. You can upload up to 2 files.

Both you and your legal guardian/birth parent must upload photo’s for consent. And parent/legal guardian must be on premises fir duration of tattoo process

Parent or guardian ID

Click or drag files to this area to upload. You can upload up to 2 files.

Addresses must match that of minor otherwise I can not tattoo them sorry.

Medical background – please check all that apply *

• Currently taking blood thinners
• Faint or dizzy spells
• Diabetes
• HIV/AIDS
• Hemophilia or similar blood disorders
• Heart condition
• Epilepsy
• Skin conditions : eczema/psoriasis
• Tuberculosis (TB)
• History of scarring or keloid
• Herpies
• Asthma
• Hepatitis
• Pregnant/nursing
• Choice 15
• NONE OF THE ABOVE

Legal stuff..Please check all below to be permitted to get tattooed *

• 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, and/or soap. Having been informed of this information I still wish to proceed with my tattoo.
• I agree/understand the tattoo process is an invasive procedure and consists of the imbedding of dyes &/or pigments into the skin with needles & the tattoo will be permanent that if i have any allergies to certain food or any organic materials this has been explained to me in my consultation & wish to proceed at my own risk.
• I agree I do not have a heart condition if i do, i have spoken with my doctor and have been advised of any concerns and still wish to proceed with this proceedure at my own risk
• I am not under the influence of drugs or alcohol
• I have not had hepatitis within the last year. I am not a haemophiliac (bleeder).
• To my knowledge, i do not have a physical, mental, medical impairment or disability which might affect my well being as a direct or indirect result of my decision to have tattoo, piercing or laser removal treatment work done at this time.
• I agree that should touch up work be required as a result of my own negligence, it will be up to the artist to decide if a fee should be charged. I understand that some colors do not show up as prominently on darker skin as opposed to lighter skin
• I agree I 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 by the negligence or fault of either the Artist or the Tattoo Studio, or otherwise
• I agree 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 initial this provision, please advise and remind your Artist and the Tattoo Studio NOT to take any pictures of you and your completed tattoo!
• I agree/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 Art
• 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
• 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 Or Laser Tattoo Removal
• I understand that Verbal AND written aftercare will be provided to me at the time of/after the procedure. I have also taken the time to review the aftercare requirements@ www.inkisart.ca/aftercare, and my aftercare requirements have already been explained during my consultation I am prepared to adhere to all the requirements necessary to heal my tattoo
• I am aware that infection could happen at no fault of the artist and should I experience any pain or swelling or symptoms of infection I should seek prompt medical attention within 24 hours

PLEASE NOTE: By clicking submit (below) you (If under 18, your legal guardian) agree to all terms set forth in this waiver and agree to proceed with a tattoo by an artist at Ink Is Art Tattoo Lounge.

Check list of items to bring with you! *

• The script/dates (if any )are verified and correct spelling/and correct dates times.
• Water and a sugary drink for recovery
• A snack with CARBS
• A method of payment cash/card – no e-transfers!
• Socks/slippers and sweater or blanket
• You have eaten 1-2 hours prior to your appointment yes?
• No caffine please!
• SMOKERS! – frequent smoke breaks can not only disrupt my creative flow and impact your tattoo outcome, AND also increase exposure and risks to bacteria and germs and infection- impact your pain threshold and extend the tattoo time. I generally break every 1.5 hours for 5-10 min – additional smoke breaks will not be excluded from the tattoo session chargeable time- so please bring nicotine gum/patches or other devices to extend your typical smoke breaks during this time.

Please be sure to bring these items with you to your appointment- do not leave in your car! I am not sure of your food allergies or intolerances and should you go into shock and require a recovery item im not legally allowed to provide!

One last bit— before your apt.. please confirm the following *

• The script/dates (if any )are verified and correct spelling/and correct dates times if not please verify once you arrive.
• All questions have been answered satisfactorily- if you have any at time of apt please don’t hesitate to ask
• You have been fully informed of all aftercare and agree to adhere to it at the best of your ability- all in previous emails and documents sent prior to your apt.
• Your aware of all risks associated with getting a tattoo and you agree to proceed
• We have discussed your tattoo and made any/aall changes and You approve the design and ready to begin. Any changes/modifications after the tattoo is completed today will be an added expense.
• You understand at any point after you go home that if you suspect something is wrong/or possible infection you will seek medical attention from a healthcare provider/walk-in clinic as soon as possible..

Please be sure to bring these items with you to your appointment- do not leave in your car! I am not sure of your food allergies or intolerances and should you go into shock and require a recovery item im not legally allowed to provide!

Submit

Cash Payments are preferred at your appointment

However Debit and Credit payment options are available.

Please no E-transfer unless previously discussed.

Questions please email me

christine@inkisart.ca