PLEASE WRITE YOUR INITIALS IN THE BOXES PROVIDED AFTER READING TO SHOW THAT YOU UNDERSTAND EACH PROVISION . 1 - In consideration of receiving a tattoo from Juri Guljajev "GUVX TATTOO", I agree to the following: 2 - I am "CLIENT" * 3 - The "Client", have been fully informed of the inherent risks associated with getting a tattoo. * 4 - 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 melanoma, allergic reactions to tattoo pigment, latex gloves and/or soap. Having been informed of the potential risks associated with getting a tattoo 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 confirm that I have read and understand the information provided to me under the "General Risks" link at the end of this consent form. * 5 - WAIVE AND RELEASE to the fullest extent permitted by law JURI GULJAJEV, operating as GUVX TATTOO, 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 JURI GULJAJEV, GUVX TATTOO, or otherwise. * 6 - The Juri Guljajev, operating as GUVX TATTOO, 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 total satisfaction. * 7 - I acknowledge that it is possible that the tattoo can become infected, particularly if I do not follow the instructions given to me by GUVX TATTOO. If any touch-up work to the tattoo is needed due to my own negligence, I agree that the work will be done at my own expense. * 8 - I am not under the influence of alcohol or drugs, and I am voluntarily submitting to be tattooed by Juri Guljajev, operating as GUVX TATTOO, without duress or coercion. * 9 - I do not suffer from diabetes, epilepsy, haemophilia, allergies, heart condition(s), an autoimmune disease, immunosuppression or immunocompromised conditions, sarcoidosis, nor do I take blood-thinning medication. If I have any of the above-mentioned conditions and still want a tattoo, I have consulted my doctor, sought advice, and came to a conclusion that I want to get a tattoo with my own choice. * 10 - I do not have any other medical or skin conditions, such as, but not limited to, skin infection, allergies, damaged skin or moles, active skin disease, areas of skin that have been subjected to plastic surgery or radiotherapy, a tattoo spot that has not healed yet or where a tattoo has been recently lasered or removed by another method, that may interfere with the procedure, application, or healing of the tattoo. I am not getting a tattoo on a mole or a scar left over from the removal of a melanoma. I am not the recipient of an organ or bone marrow transplant or, if I am, I have taken the prescribed preventative regimen of antibiotics that is required by my doctor in advance of any invasive procedure such as tattooing or piercing. I am not pregnant, breast-feeding or nursing. I do not have a mental impairment that may affect my judgement in getting the tattoo. * 11 - Juri Guljajev, operating as GUVX TATTOO, is not responsible for the meaning or spelling of the symbol or text that I have provided or chosen from the flash (design) sheets, and I fully understand that it is my responsibility to double-check the spelling and the positioning or the placement of the tattoo stencil before the tattooing takes place. * 12 - I understand that variations in color and design may happen between the tattoo art I have chosen and the actual tattoo when it is applied to my body. I also understand that over time, the colours and clarity of my tattoo will fade due to unprotected exposure to the sun and the naturally occurring dispersion of pigment under the skin. * 13 - I understand that the 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, in all likelihood, will not result in the restoration of my skin to its exact appearance before being tattooed. * 14 - I waive the right to any photographs taken of me and the tattoo and give consent in advance to their reproduction in print or electronic form. (For assurance, if you do not initial this provision, please INFORM Juri Guljajev / GUVX TATTOO NOT to take any pictures of you or your tattoo). * 15 - I agree that Juri Guljajev, operating as GUVX TATTOO, has a NO REFUND policy on tattoos, and/or retail sales, and I will not ask for a refund for the tattoo or purchase of any retail items sold by GUVX TATTOO for any reason whatsoever. * 16 - I agree to reimburse Juri Guljajev / GUVX TATTOO for any attorneys’ fees and costs incurred in any legal action I bring against them, in which Juri Guljajev / GUVX TATTOO is the prevailing party. I agree that the courts located in the city of Amsterdam, the Netherlands shall have exclusive jurisdiction and venue for the purposes of litigating any dispute arising out of or related to this agreement. * 17 - I acknowledge that I have been given adequate opportunity to read and understand this document. It was not presented to me at the last minute, and I understood that I am signing a legal contract waiving certain rights to recover damages against Juri Guljajev / GUVX TATTOO. * The Date of signing the consent form * MM DD YYYY WRITE YOUR FULL NAME * First Name Last Name Date of Birth * MM DD YYYY Email * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country * I confirm that I am over 18 years old and have presented valid photo identification upon request. I am competent to sign this form. I have read the consent form and the privacy policy. I understand them and agree to be bound by them. I confirm Thank you! GENERAL RISKSPRIVACY POLICY
