• Waiver & Release for Eric Burns @ 1757 Ink

    For appointments with Eric

  • No person shall tattoo a person less than eighteen years of age, knowing or having reason to believe such person is less than eighteen years of age except (i) in the presence of the person's parent or guardian.


    In addition, no person shall tattoo any client unless he complies with the Centers for Disease Control and Prevention's guidelines for "Universal Blood and Body Fluid Precautions" and provides the client with the following disclosure: 

    • Tattooing is an invasive procedure in which the skin is penetrated by a foreign object. 
    • If proper sterilization and antiseptic procedures are not followed by the tattoo artist, there is a risk of transmission of blood borne pathogens and other infections, including, but not limited to, human immunodeficiency viruses (HIV)as well as Hepatitis B and C viruses. 
    • Tattooing may cause allergic reactions in persons sensitive to dyes or the metals used in ornamentation. 
    • Tattooing may involve discomfort or pain for which appropriate anesthesia cannot be legally made available by the person performing the tattooing unless such person holds the appropriate license from a Virginia health regulatory board. 

    Listed below are some of the possible risks and dangers associated with the application of a tattoo: 

    • The possibility of discomfort or pain; 
    • The risk of infection; 
    • The possibility of allergic reactions to the pigments or other metals used; 
    • The permanence of the markings and the risks associated with tattoo removal 
      NOTE: The Commonwealth of Virginia makes no endorsement of the safety of the practice of tattooing.
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  • PLEASE SIGN AFTER READING ALL PROVISIONS, THEREBY ACKNOWLEDGING YOU AGREE TO EACH.

    In consideration of receiving a tattoo from 1757 Ink including its artists, associates, apprentices, agents, or any employees (hereinafter referred to as the “Tattoo Studio”) I agree to the following:

  • I,   *   *   have been fully informed of the risks associated with getting a tattoo. 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, aftercare products 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 the Tattoo Studio 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 the Tattoo Studio, or otherwise.

  • The Tattoo Studio has given me the full opportunity to ask any question about the procedure and application of my tattoo and all of my questions have been answered to my satisfaction.

  • The Tattoo Studio will provide 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   *   suffer from diabetes, epilepsy, hemophilia, heart condition(s), nor do I take blood thinning medication. I do not have any other medical or skin condition 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 judgment in getting the tattoo.

    If you have any of the medical/skin conditions listed, please list below and verbally notify your artist.
       

  • I   *   allergic to lidocaine, and consent to the use of a lidocaine solution as a numbing agent during the application of my tattoo. If you are allergic to lidocaine or do not want it to be used, please inform your tattoo artist prior to beginning the procedure.
    If you are allergic to either, please select below and notify your artist.            

  • The Tattoo Studio is not responsible for the meaning or spelling of the symbol 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.

  • *   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 wish to give consent please inform the Tattoo Studio NOT to take any pictures of you and your completed tattoo).      

  • I agree that the Tattoo Studio 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 the Tattoo Studio for any attorneys' fees and costs incurred in any legal action I bring against the Tattoo Studio and in which either the Artist of the Tattoo Studio is the prevailing party. I agree that the courts located in the County of Loudoun within the State of Virginia 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.

  • I acknowledge that I have been given adequate opportunity to read and understand this document 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 Tattoo Studio. If any provision, section, subsection, clause or phrase of this release is found to be unenforceable or invalid, that portion shall be severed from this contract. The remainder of this contract will then be construed as though the unenforceable portion had never been contained in this document.

  • I hereby declare that I am of legal age (and have provided valid proof of age and identification) and am competent to sign this Agreement.

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

    *   Pick a Date*   

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