Starnes Ink Tattoo

WAIVER, RELEASE AND CONSENT TO TATTOO

Please read this page carefully and fill out the form to proceed with your tattoo procedure.

1. *

I have been fully informed of the inherent risks associated with receiving a tattoo. I fully understand that these risks, known and unknown, can lead to injury, including but not limited to infection, scarring, difficulties in detecting 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 still wish to proceed with the tattoo application and freely accept and expressly assume any and all risks that may arise from tattooing.

2. *

TO WAIVE AND RELEASE, to the fullest extent permitted by law, the artist (Mark Starnes) and the tattoo studio from all liability whatsoever, for 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 application of my tattoo, whether caused by the negligence or fault of either the artist or the tattoo studio, or otherwise.

3. *

That both the artist and the tattoo studio have given me the full opportunity to ask any and all questions about the application of my tattoo and all of my questions have been answered to my total satisfaction.

4. *

The artist and the tattoo studio have given me instructions on the care of my tattoo while it’s healing, and I understand them 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 touchup work to the tattoo is needed due to my own negligence, I agree that the work will be done at my own expense.v

5. *

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

6. *

I do not have diabetes, epilepsy, hemophilia, a heart condition, nor do I take blood thinning medication. I do not have any other medical or skin conditions that may interfere with the 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 preventive regimen of anti-biotics 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 judgment in getting the tattoo.

7. *

Neither the artist nor the tattoo studio is responsible for the meaning or spelling of the symbol or text that I have provided to them or chosen from an outside source (such as from a friend, family member, or the internet).

8 *

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.

9. *

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 prior to being tattooed.

10. *

I release all rights to any photographs taken of me and the tattoo and give consent in advance to their reproduction in print or electronic form. If you do not initial this provision, please advise the tattoo artist NOT to take any pictures of you and your tattoo.

11. *

I agree to reimburse Mark Starnes/ Starnes Ink for any attorney’s fees and costs incurred in any legal action I bring against Mark Starnes/ Starnes Ink and in which either Mark Starnes/ Starnes Ink is the prevailing party. I agree that the courts of Maryland in St. Mary’s County, shall have personal jurisdiction and venue over me and shall have exclusive jurisdiction for the purpose of litigating any dispute arising out of or relating to this agreement.

12. *

I acknowledge that I have been given adequate opportunity to read and understand this document, that it was not presented to me at the last minute, and I understand that I am signing a legal contract waiving certain rights to recover against the Artist and the Tattoo Studio.

I HAVE READ THIS AGREEMENT, I UNDERSTAND IT, I AGREE TO BE BOUND BY IT.

You may upload photos of your ID/Driver's License (Front and Back) or a copy can be made at the start of your scheduled appointment.

Upload clear photos that show all of the info. front and back including your ID photo.

Medical Questionnaire (*Check all that apply)

Do you have any other medical or skin conditions that may affect the outcome of your procedure? If yes, explain in notes section.

Please list any important notes we should know.

Consent to Tattoo *

By checking this box, I acknowledge that I have been given adequate opportunity to read and understand this document, that it was not presented to me at the last minute, and I understand that I am signing a legal contract waiving certain rights to recover against the Artist and the Tattoo Studio.

E-Sign *

I confirm that all information I have provided is complete and true to the best of my knowledge.