Full Legal Name *

First Name

Last Name

Pronouns

She/Her/Hers

He/Him/His

They/Them/Their(s)

Other

Prefer not to say

Clients Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number *

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Clients DOB *

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PLEASE CHECK THE BOXES PROVIDED AFTER READING TO SHOW THAT YOU UNDERSTAND EACH PROVISION. FEEL FREE TO ASK ANY QUESTIONS REGARDING THIS WAIVER. *

In consideration of receiving a tattoo from Megan Reidhead including its artists, associates, apprentices, agents, or any employees (hereinafter referred to as “Queen City Ink”) check boxes saying I agree to the following:

I have been fully informed of the inherent risks associated with getting a tattoo. 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 and 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 WAIVE AND RELEASE to the fullest extent permitted by law any person of Queen City Ink 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 either Queen City Ink, or otherwise.

Queen City Ink 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.

Queen City Ink has given me instructions on the care of my tattoo while it's healing. I understand and will follow them. I acknowledge that it is possible that the tattoo can become infected, particularly if I do not follow the instructions given to me. 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.

I am not under the influence of alcohol or drugs, and I am voluntarily submitting to be tattooed by the Tattoo Studio without duress or coercion.

I do not suffer from diabetes, epilepsy, hemophilia, heart condition(s), nor do I take blood thinning medication. I do not have/suffer from any communicable disease, hemophilia, allergies/adverse reactions to pigment, dyes, disinfectants or soaps, epilepsy, seizures, fainting or narcolepsy, anticoagulants and any other information that would aid the body artist in the client’s healing process evaluation. I do not have any existing skin lesions or I do not have any other medical condition, skin condition or skin disease that may interfere with the procedure, application or healing of the tattoo. 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 or nursing. I do not have a mental impairment that may affect my judgement in getting the tattoo.

Queen City Ink is not responsible for the meaning or spelling of the symbol(s) or text that I have provided to them or chosen from the flash (design) sheets

Variations in color and design may exist between the tattoo art I have selected and the actual tattoo when it is applied to my body. I also understand that over time, the colors and the clarity of my tattoo will fade due to unprotected exposure to the sun and the naturally occurring dispersion of pigment under the skin.

A 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 which in all likelihood will not result in the restoration of my skin to its exact appearance before being tattooed.

I release 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 Queen City Ink NOT to take any pictures of you and your finished tattoo).

I agree that Queen City Ink has a NO REFUND policy on tattoos and/or retail sales and I will not ask for a refund for any reason whatsoever.

I agree to reimburse Queen City Ink for any attorneys' fees and costs incurred in any legal action I bring to Queen City Ink and in which the Artist of Queen City Ink is the prevailing party. I agree that the courts located in the County of Denver within the State of Colorado shall have jurisdiction and venue over me and shall have exclusive jurisdiction for the purposes of litigating any dispute arising out of or related to this agreement if I am located in Colorado;; and I agree that the courts located in the County of Los Angeles within the State of California shall have jurisdiction and venue over me and shall have exclusive jurisdiction for the purposes of litigating any dispute arising out of or related to this agreement if I am located in California.

I acknowledge that I have been given adequate opportunity to read and understand this document that was not presented to me at the last minute and grasp that I am signing a legal contract waiving certain rights to recover damages against the Queen City Ink.

Date *

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