Todays Date *

MM

DD

YYYY

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth *

MM

DD

YYYY

Waiver and Release of Liability *

I hereby irrevocably waive, release, and discharge, to the fullest extent permitted by law, the tattoo artist(s) and The Fountainhead Tattoo Inc. (the “Studio”), including their owners, agents, employees, contractors, and representatives, from any and all claims, demands, causes of action, damages, or liabilities of any kind whatsoever—whether known or unknown—arising out of or relating in any way to the application, design, placement, or healing of my tattoo. This release includes, without limitation, claims for personal injury, bodily harm, infection, scarring, allergic reactions, or any direct, indirect, incidental, or consequential damages, whether caused by the negligence or fault of the artist, the Studio, or otherwise.

I consent

Consent and Age Verification *

I affirm that I am at least eighteen (18) years of age and have presented valid government-issued photo identification. If I am under eighteen (18) years of age, I confirm that my legal guardian is present and has also provided valid government-issued photo identification and consent.

I am of legal age

I have my legal guardian with me

Sobriety and Voluntary Consent *

I affirm that I am not under the influence of alcohol, drugs, or any intoxicating substances, and that I am voluntarily submitting to this procedure without coercion or undue influence.

I agree

Medical Disclosure *

I have fully disclosed to the artist any and all medical conditions, including but not limited to diabetes, epilepsy, heart conditions, hemophilia, or dermatological conditions, that could affect the tattoo process or healing. I further affirm that I am not pregnant or nursing at the time of this procedure.

I have

Needle-Stick or Exposure Consent *

In the event of an accidental needle-stick injury or other potential exposure (including through eyes, mouth, nostrils, or open skin), I consent to voluntarily submit to a blood test or other appropriate medical testing for the safety of the artist and Studio personnel.

Yes

Aftercare and Responsibility *

I acknowledge that I have received and understand verbal and/or written aftercare instructions from the artist. I agree that it is solely my responsibility to properly care for the tattoo in accordance with these instructions. I understand that failure to comply with such aftercare may result in infection or other complications. I further agree to contact the Studio directly with any questions before seeking advice from any third party.

Yes

Photography and Use of Images

I hereby grant the Studio and its agents the irrevocable right to photograph, reproduce, and use images of me and/or my tattoo in any media for lawful promotional or artistic purposes, without further compensation or notice.

Yes

No (If “No,” I will verbally inform the artist prior to the procedure.)

Design Approval and Artistic Trust *

I acknowledge that I have been given the opportunity to review and approve my tattoo design prior to the procedure. I understand that tattooing is an art form subject to interpretation and agree to accept full responsibility for any design elements, including but not limited to spelling, placement, or stylistic details.

I have

ONE MORE THING before super fun tat time. We understand that our clients and staff are ridiculously good looking but I agree not to hit on or slide into anyones DM's unless otherwise advised. *

I also realize this should go without saying but some people have given us no choice, So here we are

I agree (and am laughing now)

or I'll just leave now