Online Waiver

Complete this waiver before your appointment so we can keep the in-studio check-in quick and organized. The form saves directly to the studio records once submitted.

Participant under 18? Please use our youth waiver instead.

What we collect

Participant first and last name
Phone number, email address, and date of birth
Signature and consent acknowledgement
Emergency contact first and last name plus phone number
Driver's license or ID number and issuing province/state

In consideration of receiving a tattoo from Lightning Bug Tattoos, all artists, associates, apprentices, and any associates will be included, protected and referred to as Lightning Bug Tattoos in this document.

I WILL INFORM MY ARTIST IF ANY OF THE BELOW APPLY

Am currently pregnant or breastfeeding
Am positive for blood-borne pathogens
Have epilepsy
Have known allergies
Am prone to fainting
Have consumed alcohol or drugs within the last 24 hours
Am currently taking any medication affecting my blood
Am experiencing a bacterial infection/ on antibiotics
Have a skin condition affecting the desired tattoo area
Have other medical issue pertaining to this procedure

I have been fully informed of the inherent risks associated with getting a tattoo. Therefore, I fully understand that these risks, known and unknown, can lead to injury including but not limited to: infection, scarring, difficulties in the detection of illness and allergic reactions.

I am informed of the potential risks associated with getting a tattoo and I wish to proceed with the tattoo procedure and application and freely accept and expressly assume any and all risks that may arise from tattooing.

I WAIVE AND RELEASE to the fullest extent permitted by law any person of Lightning Bug Tattoos from all liability whatsoever, including but not limited to, 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 procedure and application of my tattoo, whether caused by the negligence or fault of either the Tattoo Studio, or otherwise.

I agree to pay my artist in full for the artist’s work and the $20 shop set up fee.

I agree to void any monetary gain, fees, intellectual design ownership in regards to body modification or design that I have received from Lightning Bug Tattoos.

I understand Lightning Bug Tattoos has given me the full opportunity to ask any question about the procedure and application of my tattoo and all of my questions, if any, have been answered to my satisfaction.

I consent to all appropriate physical contact in regards to tattoo application or body modification.

I understand Lightning Bug Tattoos has given me instructions on the care of my tattoo while it's healing. I understand and will follow them. I acknowledge that it is possible that the tattoo can become infected, particularly if I do not follow the instructions given to me. If any extra work to the tattoo is needed due to my own negligence, I agree that the work will be done at my own expense.

I am not under the influence of alcohol/drugs or mind altering substances that could impair my judgement.

I voluntarily agree to be tattooed by my artist without duress or coercion.

I have disclosed any medical information which may affect the outcome of my tattoo.

I to my knowledge, I do not have any physical, mental, medical impairment or disability that might affect my well-being as a direct or indirect result of my decisions to have any body modification done at this time.

I to my knowledge, I do not have any ailments that may be dangerous to any one working in association with and if so, it has been specified to my artist.

I agree Lightning Bug Tattoos is not responsible for the meaning or spelling of the symbol or text that I have provided to them or chosen from the design sheets.

I understand variations in colour and design may exist between the tattoo art I have selected and the actual tattoo when it is applied to my body. I also understand that over time, the colours and the clarity of my tattoo will fade due to unprotected exposure to the sun and the naturally occurring dispersion of pigment under the skin.

I understand a tattoo is a permanent change to my appearance and can only be removed by laser or surgical means, which can be disfiguring and/or costly and which in all likelihood will not result in the restoration of my skin to its exact appearance before being tattooed.

I understand and agree that the Tattoo Studio has a NO REFUND policy on tattoos, piercing and/or retail sales and I will not ask for a refund for any reason whatsoever.

I agree to reimburse Lightning Bug Tattoos for any attorneys' fees and costs incurred in any legal action I bring against the Tattoo Studio.

I agree to pay for any and all damages or injuries to any persons in association with Lightning Bug Tattoos and/or property belonging to or used by Lightning Bug Tattoos, caused by or resulting from my actions while I am at Lightning Bug Tattoos.

I agree that this release form also pertains to and is designed to protect any and all establishments where Lightning Bug Tattoos conducts business.

I acknowledge that I have been given adequate opportunity to read and understand this document.

I understand that I am signing a legal contract waiving certain rights to recover damages against Lightning Bug Tattoos.

I hereby declare that I am of legal age 18+ (and have provided valid proof of age and identification) and am competent to sign this Agreement.

I understand this form will be kept on file and will need to be updated yearly needs to be added.

I understand and have answered honestly to the best of my abilities.

Waiver Form

Participant First Name

Participant Last Name

Email Address

Phone Number

Date of Birth

Driver's License / ID Number

Country of Issuing ID

Issuing Province / State

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Phone

Signature

Draw your signature in the box above.

By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.