Revel Road Tattoo Waiver

REVEL ROAD TATTOO WAIVER, RELEASE AND CONSENT FORM

This Tattoo Waiver, Release and Consent Form applies only to individuals who are eighteen (18) years of age or older. By signing this form, I acknowledge and represent that I am at least eighteen (18) years of age and legally able to consent to receiving a tattoo.

*Customer Information Recorded Below.

HEALTH RISK ADVISORY & DISCLOSURES

I understand that tattooing involves inherent health risks including, but not limited to:

• Allergic reactions to tattoo pigments, inks, or aftercare products
• Skin infections and tissue damage
• Scarring, hypertrophic scarring, keloid formation, or changes in skin texture
• Prolonged bleeding, bruising, redness, or swelling
• Pain and general discomfortInk migration, fading, or changes in tattoo appearance over time
• Unsatisfactory aesthetic results or differences between the expected and actual healed appearance
• Febrile illness, tetanus, or systemic infection
• Potential complications in identifying skin conditions, skin cancer, or other abnormalities in tattooed areas

Medical Conditions That May Increase Risk:

The following medical conditions or circumstances may increase the risk of complications from receiving a tattoo:

• DiabetesHemophilia or bleeding disorders
• Heart disease
• Skin disorders, diseases, lesions, or sensitivities to soaps, disinfectants, inks, pigments, or topical products
• Skin cancer or melanoma
• Allergies or sensitivities to metals, pigments, dyes, latex, or topical products
• Anaphylactic reactions or severe allergies
• Epilepsy, seizures, fainting, or narcolepsy
• Peripheral nerve diseaseImmune system or circulatory system deficiencies
• Use of anticoagulants or medications that thin blood or interfere with clotting
• Hepatitis or HIV
• History of infection
• Pregnancy or breastfeeding
• Any condition affecting the immune system
• Any other known or unknown medical condition

I hereby acknowledge that:

• I have been advised to consult with a physician prior to this procedure if I fall into any heightened risk categories.
• If I have any medical conditions, including but not limited to those listed in the HEALTH RISK ADVISORY & DISCLOSURES section, I have consulted with a physician and received approval to proceed with the tattoo.
• If I am taking blood-thinning medications, antibiotics, have diabetes, have a history of infection, or have any other medical condition that may increase risk, I have consulted with a physician and received approval to proceed with the tattoo.
• I have truthfully and fully disclosed all relevant medical information and history to Revel Road staff.
• I am NOT under the influence of alcohol or drugs.
• I have NOT taken anticoagulants, antiplatelet drugs, or NSAIDs (aspirin, ibuprofen, etc.) in the last 24 hours unless otherwise approved by my physician.
• I am voluntarily choosing to proceed with knowledge of these risks.

EQUIPMENT & PROCEDURE

I understand that:

• My tattoo will be performed using sterile, single-use needles and properly sanitized equipment.
• Single-use disposable materials will be utilized whenever applicable.
• The tattoo artist will use appropriate aseptic techniques and properly cleanse and prepare the area before the procedure.
• The tattoo procedure involves the insertion of pigment into the skin and may result in temporary discomfort, bleeding, redness, swelling, and irritation.
• No guarantee has been made regarding the exact appearance, longevity, color retention, or healing outcome of the tattoo.

PERMANENCE & AFTERCARE

Permanence:

I understand that tattoos are permanent in nature. While tattoos may fade over time and can sometimes be altered or removed through medical procedures, removal may be expensive, painful, incomplete, and may result in scarring.

Aftercare Responsibility:

• I understand the importance of proper aftercare in reducing the risk of infection or other medical complications.
• Despite best efforts and proper aftercare, the potential for infection, allergic reaction, or complications still exists.
• Improper aftercare, poor hygiene, excessive sun exposure, friction, picking, scratching, or other factors may negatively impact healing and the final appearance of the tattoo.
• Certain medical conditions, medications, and treatments can impede healing.
• Healing times and final tattoo appearance cannot be guaranteed.
• I have read, understand, and agree to follow the TATTOO AFTERCARE INSTRUCTIONS provided to me both verbally and in writing.
• Since Revel Road will not monitor my at-home aftercare, it is solely my responsibility to follow the aftercare instructions.

I should consult a healthcare provider for:

• Unexpected redness, excessive tenderness, worsening swelling, increasing pain, or warmth at the tattoo site.
• Excessive discharge, rash, unusual odor, or signs of infection.
• Fever or symptoms of illness following the procedure.
• Any signs of an allergic reaction or adverse response.

PHOTOGRAPHIC RELEASE

I grant permission and consent to Revel Road for the use of close-up photographs of the completed tattoo for presentation under any legal condition, including but not limited to publicity, copyright purposes, illustration, advertising, marketing, social media, and web content.

Furthermore, I authorize Revel Road to take photographs and/or videos of my tattoo procedure for internal training, quality assurance, and educational purposes.

I wish to opt-out of having my images used for internal training purposes.

I understand there shall be no payment, royalties, or other compensation for this release.

RELEASE OF LIABILITY / WAIVER OF CLAIMS

In signing this Release of Liability/Waiver of Claims, I hereby acknowledge and represent that:

I HAVE READ THIS RELEASE, UNDERSTAND IT, AND SIGN IT VOLUNTARILY.

• I confirm that I am eighteen (18) years of age or older and legally capable of consenting to this tattoo procedure.
• I hold only myself liable and hereby release and waive any and all claims, known or unknown, arising out of or relating to this tattoo procedure, including claims of negligence, that I may have against Revel Road, its agents, contractors, tattoo artists, employees, and representatives with respect to this tattoo procedure.
• The foregoing release is intended to benefit all of the named parties and will be enforceable by such parties as third-party beneficiaries.
• I hereby agree to accept and assume all risks of illness, personal injury, psychological injury, pain, suffering, disability, death, property damage, and/or financial loss arising from this tattoo procedure.

I acknowledge that I am aware of and intentionally waive any rights I may have under statutes like California Civil Code § 1542, which provides: “A general release does not extend to claims that the releasing party does not know or suspect to exist in his or her favor at the time of executing the release and that, if known by him or her, would have materially affected his or her settlement with the released party.” I expressly waive and relinquish all rights and benefits under that section and any law of any jurisdiction of similar effect with respect to the claims released herein.

Indemnification:

I further agree that should I or anyone acting on my behalf make a claim against Revel Road, its agents, contractors, tattoo artists, employees, or representatives for compensation for damages or harm allegedly incurred because of negligence or other alleged actions, I shall indemnify, defend, and hold harmless Revel Road, its agents, contractors, tattoo artists, employees, and representatives against all such claims and associated costs, including any attorney fees incurred in defending against such claims.

Additional Acknowledgments:

• I understand that providing false information regarding my age or identity may constitute fraud and may invalidate my consent to receive a tattoo.
• I understand that I must carefully follow all aftercare instructions and hereby release Revel Road and any partners from any claims resulting from my failure to follow those instructions.
• I acknowledge that tattoo appearance may vary due to individual skin type, skin tone, healing, lifestyle, placement, and aftercare, and that no guarantees have been made regarding exact color retention, line clarity, or final healed results.
• This waiver does not extend to claims for gross negligence, willful misconduct, or any other liabilities that law does not permit to be released by agreement.
• All information I have provided is true and correct.
• I willingly submit to this tattoo procedure.

Severability:

I expressly agree that this Release of Liability/Waiver of Claims is intended to be as broad and inclusive as permitted by law. If any provision is held invalid or otherwise unenforceable, the remaining provisions shall remain enforceable.

Privacy:

No personal information provided within this waiver will be shared with any third party unless required by law.

Venue; Waiver of Jury Trial:

I agree that any action or proceeding arising out of or relating to this Tattoo Waiver, Release and Consent Form shall be brought exclusively in the courts of Maricopa County, Arizona, and I waive any right to a jury trial in connection with any such action or proceeding.

Entire Agreement; Interpretation:

This Tattoo Waiver, Release and Consent Form constitutes the entire agreement between the parties concerning the subject matter hereof and supersedes all prior agreements, understandings, negotiations, and discussions, whether oral or written, between the parties. No amendment, modification, or waiver of any provision of this form shall be effective unless in writing and signed by both parties. This form will not be interpreted against Revel Road as the drafter.

SIGNATURE

I, the undersigned, acknowledge that I have read this Tattoo Waiver, Release and Consent Form in its entirety, fully understand and agree to its contents, confirm that I am eighteen (18) years of age or older, and hereby consent to receive the tattoo described above.