RELEASE FORM General Release and Waiver of Liability Step 1 of 3 33% Please agree to the following by choosing yes. Failure to do so may result in you not being able to get tattooed/pierced.I am 18 or older, or 16 with a parent/legal guardian who is present and is authorized by me to sign this release.* Yes No I understand that tattooing is permanent, however variations in color and design may change with artistic interpretation, and that no representations have been made to me with regard to the ability to lager change/remove this or any tattoo.* Yes No I am not pregnant or breastfeeding, nor do I suffer from any mental illnesses, diabetes, hemophilia, skin diseases/lesions, seizures, epilepsy, history of fainting or narcolepsy, neurological or immune compromised, or have any communicable diseases.* Yes No I am not currently taking blood thinning medications, anticoagulants, or anything that interferes with blood clotting.* Yes No I understand that it is not reasonably possible for any tattooist/piercer, agent, representative of Mantra Tattoo to determine whether I may have any allergic reaction to any of the dyes/pigments, or any other chemicals/processes used in tattooing/piercing, and I fully accept all of the risks involved with this procedure and any resulting outcomes including bodily injury, permanent changes to my body, or even death.* Yes No I understand that photographs/videos may be taken of me and/or anyone who accompanies me before, during, and after this procedure. I also understand that said photos/videos may be used, or published in any way seen fit by Mantra Tattoo and artist without any compensation to me or my agents.* Yes No I understand that Colorado Department of Public Health has rules governing Body Art establishments, and that Mantra Tattoo & artist is in compliance of these regulations.* Yes No I accept full and total responsibility for any/all body art services performed on my person at this time. I also agree to hold harmless/blameless, the tattooist/piercer, landlord/building owner, or any person involved in providing these services to me, due to any damage/loss of my property, and from any actions, accidents/injuries to myself before/during and after the services are performed.* Yes No I acknowledge that tattooing/piercing ay involve serious risk of injury or death. I fully understand the terms of this releae form and have signed it freely and voluntarily. My signature is a complete and unconditional release of all liability to the greatest extent of the law for any/all representatives, associates/employees of Mantra Tattoo. I understand that there are no guarantees/refunds, and I accept all responsibility for any repair work to this tattoo/piercing. Therfore I release, discharge, and agree not to sue any tattooist/piercer, employee/associate, leaser/landlord, or affiliates of Mantra Tattoo. By signing this form I waive any and all claims regarding liability, negligence, injury, or even death caused by my choice to have tattoo/piercing services provided to/on me.Today's Date* MM slash DD slash YYYY Signature of Client*I am under 18.* Yes No Today's Date* MM slash DD slash YYYY Signature of Guardian* I undersand and agree to follow these aftercare instructions for my tattoo/piercing. Cleansing of the tattoo/piercing thoroughly and frequently. Keeping the tattoo/piercing free of bodily fluids (my own or others). Cautious use of personal hygiene products or ointments which may cause infection. If excessive redness occurs, irritation, itching, pain or other signs of infection, allergic reaction or other side effects from the tattoo/piercing occur, I must immediately notify my tattooist/piercer and my personal physician. I have been given written aftercare instructions regarding proper care of my tattoo/piercing to be followed immediately after the procedures are completed. I understand that these instructions are important and that failure to adhere to them can complicate healing and cause risks to my tattoo/piercing or my health and wellness. I certify and acknowledge that I have received complete information regarding the nature and procedures used in tattooing/piercing and aftercare, the permanence of tattooing, and the possible complications or side effects from these procedures. By signing this I consent to the tattoo/piercing procedures requested by me, and authorize them to use on my body at this time.Name* First Last Date of Birth* MM slash DD slash YYYY Email* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Driver's License # or I.D#* Phone*Today's Date* MM slash DD slash YYYY Signature of Client*Today's Date* MM slash DD slash YYYY Signature of Guardian*Snap a photo of your drivers license and upload it here.*Max. file size: 10 MB. For Office UsePlease pass the form back to our team representative to finialize. Tattoo or Piercing?* Tattoo Piercing Description, Location of Tattoo/Piercing*Artist/Piercer* Body Art License #* Sterilization Info: Lot #* Description of Tools Sterilized* Sterilization Info: Lot #* Description of Inks Used* Needles Used: Liner* Lot#* Needles Used: Shader* Lot#* Piercing Needle* Lot#* Inks Used in Tattoo* Black Red/Pink Dk. Blue/Blue/Lt. Blue Dk. Green/Green Lt./Lime Green Aqua/Teal Purple/Lavender Dk. Brown/Brown/Tan Orange Yellow White Todays Date* MM slash DD slash YYYY