I acknowledge by signing this agreement that I have been given the full opportunity to ask any and all questions which I might have about obtaining a tattoo and that all of my questions have been answered to my full satisfaction. I acknowledge and I am aware that the inherent and other risks, hazards and dangers, including those unknown and unanticipated (hereinafter referred to collectively as “Risks”) of getting a tattoo cannot be eliminated and can cause injury, damage, death, and/or other loss to me or others. I acknowledge that there is are skateboarding ramps outside of the Lumenati premises, and I may use them at my own risk. Therefore, I assume and accept full responsibility for the Risks, both known and unknown associated with getting a tattoo, using the skatepark, and for any and all injury, damage, death and/or other loss suffered by me and/or from my negligence and/or other misconduct and/or that of others. I understand that getting a tattoo is dependent upon my knowing and voluntary execution of this Agreement, that I am not permitted to get a tattoo without executing this Agreement. Lumenati Tattoo, LLC (“Lumenati”) and my tattoo artist (who may not be an employee of Lumenati) is entitled to and shall rely upon this Agreement.
I specifically acknowledge I have been advised of the facts and matters set forth below and I agree as follows:
- If I have any communicable disease, heart condition or take medicine (like anticoagulants or other medications) which thins the blood or interferes with blood clotting I have advised my tattoo artist. I am not pregnant or nursing.
- I am not under the influence of alcohol or (illicit or legal) drugs, including without limitation marijuana.
- I do not have any medical or skin condition, such as but not limited to: acne, scarring (Keloid), Eczema, psoriasis, rash, infection, lesion, freckles, moles or sunburn in the area to be tattooed that may interfere with said tattoo. If I have any type of infection, scratch, rash, or lesion anywhere on my body, I will advise my tattoo artist.
- If I have now or have a history of any of the following conditions, I will advise my tattoo artist: diabetes, hemophilia, allergies or adverse reactions to pigments, dyes, disinfectants or soaps, history of epilepsy, seizures, fainting or narcolepsy, or any other information or condition that would aid impact my body art evaluation or healing process.
- I acknowledge it is not reasonably possible for Lumenati and the tattoo artist to determine whether I might have an allergic reaction to the pigments or processes used in my tattoo, and I agree to accept the risk that such a reaction is possible.
- I acknowledge that infection is always possible as a result of the obtaining of a tattoo, particularly in the event that I do not take proper care of my tattoo. I have received aftercare instructions and I agree to follow them while my tattoo is healing. I agree that any touch-up work needed due to my own negligence or failure to follow such instructions will be done at my own expense.
- I realize that variations in color and design may exist between any tattoo as selected by me and as ultimately applied to my body. I understand that if my skin color is dark, the colors will not appear as bright as they do on light skin.
- I understand that if I have any skin treatments, laser hair removal, plastic surgery or other skin altering procedures, it may result in adverse changes to my tattoo.
- I acknowledge that a tattoo is a permanent change to my appearance and that no representations have been made to me as to the ability to later change or remove my tattoo. I do not have a physical, mental or medical impairment or disability which might affect my well-being as a direct or indirect result of my decision to have a tattoo.
- I acknowledge I am over the age of eighteen and that I have truthfully represented to my tattoo artist that getting a tattoo is by my choice alone. I consent to the application of the tattoo and to any actions or conduct of Lumenati and the tattoo artist reasonably necessary to perform the tattoo procedure.
I understand that Lumenati and my tattoo artist reserve all rights to use any photos, videos, or images of my tattoo taken in the studio. I hereby permit and grant Lumenati and my tattoo artist the right to copy, distribute, display, and otherwise use any photographs, images, film, or video which may contain my image, tattoo, voice, name or likeness (collectively, the “Materials”) in promotion of their respective businesses, including by posting on their website or social media feeds. I will not have any right to review, inspect, or approve any of the Materials, and I waive all right to compensation arising from their use.
Therefore, in consideration for the right to receive a tattoo and, if applicable, use the skate park, I hereby forever waive, release, relinquish, hold harmless, agree not to sue, and discharge my tattoo artist, Lumenati, Lumenati Productions, LLC, and their respective directors, officers, employees, servants, contractors, representatives, attorneys, agents, producers, affiliates, successors, assigns, designees, and licensees (hereinafter referred to collectively as “Lumenati Related Parties”) from any and all claims, losses, damages, liabilities, suits, causes of action, and/or expenses (including attorneys’ fees and costs) of any and all kind whatsoever (hereinafter referred to collectively as “Claim” or “Claims”) for any injury, damage, loss, disability, death and/or other loss arising out of or in any way connected with my tattoo, services performed by Lumenati or my tattoo artist, and/or use of any equipment, facilities and/or premises, including without limitation any use of the skatepark. In addition, I understand, acknowledge and agree that should I suffer any injury, disability, damage, death and/or other loss arising out of or in any way connected with my receiving of a tattoo and/or use of any equipment, facilities and/or premises (including use of the skatepark), I am solely and exclusively responsible and liable for any and all medical expenses incurred, and no coverage or insurance shall be provided under any policy of insurance held by Lumenati or the Lumenati Related Parties.
The skatepark is provided as-is and without any warranties – i assume all risk for my use of the skatepark. If I choose to use it, I represent that I will wear a helmet and obey reasonable safety standards. I will not use the skatepark if I am under the influence of drugs (whether illicit or legal) or alcohol.
I understand, acknowledge and agree that by signing this Agreement, I and anyone acting on my behalf or that of my estate surrender our respective rights to make a Claim against Lumenati or any Lumenati Related Parties as a result of any injury, disability, damage, death and/or other loss suffered by me. Furthermore, I agree to defend, indemnify and hold Lumenati and any Lumenati Related Parties harmless with respect to any and all Claims brought by or on behalf of me, my estate, a family member, a co-participant and/or any other person for any injury, damage, death and/or other loss arising out of or in any way connected with my tattoo and/or use of any equipment, facilities and/or premises (including the skatepark). This release and indemnity includes Claims resulting from Lumenati’s (or the Lumenati Related Parties) negligence but not its gross negligence or willful, wanton or criminal misconduct. This release and indemnity includes Claims for personal injury or wrongful death, including but not limited to Claims related to emergency or medical response, assessment or treatment, property damage, loss of consortium, breach of contract, or any other Claim.
This Agreement shall be interpreted and enforced to the fullest extent allowed by law, and if any portion of this Agreement is deemed unlawful, invalid or unenforceable, then it shall not affect the remaining provisions, and those remaining provisions shall continue in full force and effect. Any dispute between me and Lumenati, my tattoo artist, or any other Lumenati Related Party will be governed by the substantive laws (not including the laws which might apply the laws of another jurisdiction) of the State of Colorado and I consent to jurisdiction in Colorado. Any mediation or suit shall occur or be filed only in the State of Colorado. If any part of this agreement is found by a court or other appropriate authority to be invalid, the remainder of the agreement nevertheless will be in full force and effect.
By signing below, I agree that I have read the tattoo release form provided by Lumenati and agree to its terms.
I verify that I am at least 18 years of age, or have my parent or legal guardian present with me to sign below.