Client Application & Waiver Form

Clients must fill out and sign the following Client Application & Waiver Form for services at Labyrinth Tattoos, Permanent Cosmetics, and VI Laser. Please Complete All Fields

YOU MUST AGREE TO AND CHECK EACH OF THE FOLLOWING

I am at least 18 years old. (a parent consent form must be completed if you are under 18)

I do not have a heart condition, epilepsy or hepatitis. I am not a hemophiliac, or on any blood thinning medications. I do not have diabetes, AIDS, HIV or any immune deficient condition. I am not pregnant or nursing presently. If I am under the care of a Doctor for any of the above related conditions, I have been stable for at least 90 days prior to my appointment. "Stable" meaning no change in medication or dosage, and I have not been hospitalized.

I do not have any allergies, physical/mental impairment, or disability which might affect my well being as a direct result of my decision to have my body pierced or tattooed.

I am not under the influence of drugs or alcohol.

I agree to follow all instructions concerning the after care of my piercing/tattoo. I agree that any reaction or rejection will be my responsibility. If any touch ups to the tattoo are needed due to my own negligence, I agree that the work will be done at my own expense.

Being of sound mind and body, I hereby release any and all persons at Labyrinth Tattoos, Permanent Cosmetics, and VI Laser from all responsibility. I accept any and all responsibility for any consequences that might stem from my decision to have any tattoo/piercing by Labyrinth Tattoos.

I agree not to sue Labyrinth Tattoos, Permanent Cosmetics, VI Laser, and their staff past or present for any damages, claims, demands, rights and causes of action of any nature whatsoever, for any injuries or property damages or death of myself or to any other person arising from my decision to have any piercing/tattoo work done at Labyrinth Tattoos by any person whosoever.

I agree for myself, my heirs, my assignees and legal representatives to hold Labyrinth Tattoos, Permanent Cosmetics, and VI Laser blameless for any damages, actions, causes of actions, claims of action, class action suits, cost of litigation, attorney's fees, and all costs and expenses whatsoever which might arise from my decision to have any tattoo, piercing, or other work done by Labyrinth Tattoos, Permanent Cosmetics, and VI Laser.

I agree to pay for any damages to any and all persons and property belonging to Labyrinth Tattoos, Permanent Cosmetics, and VI Laser, corporate directors and employees any other persons or companies which may become libel contractually or by operation of law, caused by, or resulting from my decision to have any tattoo/piercing or other work done by Labyrinth Tattoos, Permanent Cosmetics, and VI Laser, employees or corporate directors.

I agree that this waiver also pertains to and is designed to protect any and all establishments where Labyrinth Tattoos, Permanent Cosmetics, and VI Laser, corporate directors or employees conduct tattooing, piercing, and other work.

I agree that neither the artist nor Labyrinth Tattoos, Permanent Cosmetics, and VI Laser is responsible for the meaning or spelling of the symbol or text that I have provided to them or chosen from the a flash sheet.

I authorize Labyrinth Tattoos, Permanent Cosmetics, and VI Laser to use, display, distribute, sell, alter and publish all photos taken of my tattoo/tattoos and/or piercing/piercings. I agree not to request any monies or gratuities from the use, display, distribution, sale, alteration or publication of any or all photos taken by Labyrinth Tattoos, Permanent Cosmetics, and VI Laser.

In the event I am requesting a tattoo or piercing in a discreet area (discreet is described as genitalia, breasts, buttocks and inner thigh area which would normally be covered by undergarments), I realize it may be necessary for the artist to lean and/or touch and/or stretch an area or reposition his/herself in order to facilitate the request. At no time can the artist post pictures on any/all social media or websites without my written consent.

IMPORTANT NOTES

#1. A minimum set up fee will be charged for all sessions under one hour, otherwise an hourly rate will be apply.

#2. If you receive any art work either in person or via E-mail, your deposit is non-refundable.

#3. Deposits are valid for six (6) months from receipt.

#4. Gift Certificates are non-refundable.

#5. One touch up in the first year of your tattoo is included, given the proper aftercare has been applied.

#6. Due to the nature of our skin and our lives, any work done on the hands, feet, and the back of the neck may require more frequent touch ups; touch ups will not be free.

#7. Touch ups must be done with the original artist. If you choose to see a different artist, an hourly fee will be charged.

#8. Deposits will be held and taken off the final payment of the tattoo. This ensures that a deposit is left for any consecutive appointments. (A max. of $50, or $100 for a cover-up, will be held if deposit is greater)

#9. 48 hour notice is required to postpone or cancel an appointment, otherwise you will lose your deposit.

Select the services you are interested in today:

Tattoo

Piercing

Permanent Makeup

Laser Hair Removal

Gumball Tattoo

Please let us know your Preferred Artist:

No Preference

Maria Leoczko

Rastaroy

Rai Wells

Gumball

Please supply colour details if relevant:

Colour

Black & Grey

Custom Selection

You can upload up to 5 images of your personal favourite designs:

Upload File

YOU MUST NOTE AND AGREE TO THE FOLLOWING
COVID SAFETY MEASURES

I do not have Covid-19 or been in direct contact with anyone diagnosed, suspected of, exhibiting signs or self- isolating for having COVID-19. IE: Fever, coughing, shortness of breath, muscle aches, sneezing, sore throat, headache or recent loss of taste and smell. I have not travelled outside of British Columbia, to the United States or Internationally in the past 14 days or been around anyone else who has travelled within these areas. I also do not have a known heart condition, epilepsy or hepatitis. I am not a hemophiliac, or on any blood thinning medications. I do not have diabetes, AIDS, HIV, or any immune deficient condition. I am not pregnant or nursing presently.
I acknowledge the contagious nature of the Coronavirus/COVID-19 and that of Vancouver Island Health Authority along with the CDC and many other public health authorities still recommend practicing social distancing.
I further acknowledge that Labyrinth Tattoo and VI Laser has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19.
I further acknowledge that Labyrinth Tattoos, Permanent Cosmetics, and VI Laser cannot guarantee that I will not become infected with the Coronavirus / Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus / COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, tattoo shop staff, and other tattoo shop clients and their families.
I voluntarily seek services provided by Labyrinth Tattoos, Permanent Cosmetics, and VI Laser and acknowledge that I am increasing my risk to exposure to the Coronavirus / COVID-19. I acknowledge that I must comply with all set procedures and protocols to reduce the spread while attending my appointment.
I am not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell.
I have not traveled to a highly impacted area within the United States of America or Internationally in the last 14 days.
I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19.
I have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non contagious by provincial or local public health authorities.
I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19.

I have noted and agree to the above Covid information and requirements.

I HEREBY CERTIFY THAT THE ABOVE INFORMATION I HAVE PROVIDED IS TRUE AND FACTUAL AND TO THE BEST OF MY KNOWLEDGE. THE ABOVE INFORMATION IS FOR CLINICAL RECORDS ONLY AND THIS OR ANY INFORMATION OBTAINED IS KEPT UNDER STRICT CONFIDENTIALLY.

Your Signature (REQUIRED)

Please note that it may some time for the form to submit, particularly if you are uploading files. You will see a 'Thanks for submitting!' message under the Submit button when the submission is complete:

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LABYRINTH TATTOOS: Traditional Body Tattooing, Permanent Cosmetics, Laser Hair Removal and Piercing in Nanaimo, B.C.

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