Loading...

This information is required to protect the health and safety of the client and the artist or operator. This information should be filled out completely and correctly so that the artist or operator may be aware of any conditions that could affect the procedure or outcome of the body modification. All tattoos and piercings are performed in a sterile environment by licensed technicians under the direction of the Tennessee Health Department.

Please initial each line below to acknowledge that you have read, understood, and agree to these statements.

I acknowledge that obtaining tattoos/piercings will result in a permanent change to my appearance that cannot be reversed.

I Agree

I acknowledge the tattoos and piercings are performed using appropriate, sanitary instruments and sterilization techniques. 

I Agree

I understand that infection is always a possibility as a result of body modification. I have received aftercare instructions and agree to follow all of them while my wound is healing. 

I Agree

I understand it is not reasonably possible for the representatives and employees of Studio 222 to determine if I might have an allergic reaction to the pigments or processes used my tattoo and I accept that such a reaction is possible. 

I Agree

I realize that any variations in color and design may exist between any tattoos selected by me and ultimately applied to my body I understand that if my skin color is dark, colors used will not appear as bright when the tattoo is healed. 

I Agree

I agree that my tattoo or body piercing may be photographed or filmed with my consent and may be published. 

I Agree

I agree that the identification I am presenting to Studio 222 is mine and has not been altered in any way 

I Agree

I agree that all sales are final, and no refunds will be given. 

I Agree

By signing this document, I affirm that I have read, understood, and agreed to the terms of this release in their entirety. Additionally, I agree that all information provided here is true and that I am of lawful age. I understand the terms of the agreement are contractual and this agreement is a complete and total release and is irrevocable. I also agree that in consideration of products and/or services provided to me at Studio 222 by its employees, agents, or others acting on their behalf (the releasees): I, my heirs, executors, administrators, successors, and assignees hereby release and forever discharge the releasees, their heirs, executors, demonstrators, successors, and assignees for any and from any and every claim, demand, action, or right of action, of whatever kind and character, either in law or in equity arising from or by reason of any bodily injuries, known or not know, death, property damage resulting from any products and/or services provided to me by the releasees, whether by negligence or otherwise.

Today's Date: August 1, 2025



First Participant's Name
First Name*
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
First Participant's Information
Do you have a history of low blood sugar, diabetes, hemophilia, or other blood related illness?*
No
Yes
Do you have any known allergies to any metals, plastics, or latex?*
No
Yes
Do you have any skin conditions, such as, eczema, psoriasis, or sunburn?*
No
Yes
Do you have a heart condition, epilepsy, or other serious medical condition?*
No
Yes
Are you pregnant or nursing?*
No
Yes
Are you on any medications, such as, blood thinners?*
No
Yes
Are you under the influence of any chemical substance, such as, drugs or alcohol?*
No
Yes

If you answer yes to any of the following, please explain.
First Participant's Signature*
Second Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Second Participant's Information
Do you have a history of low blood sugar, diabetes, hemophilia, or other blood related illness?*
No
Yes
Do you have any known allergies to any metals, plastics, or latex?*
No
Yes
Do you have any skin conditions, such as, eczema, psoriasis, or sunburn?*
No
Yes
Do you have a heart condition, epilepsy, or other serious medical condition?*
No
Yes
Are you pregnant or nursing?*
No
Yes
Are you on any medications, such as, blood thinners?*
No
Yes
Are you under the influence of any chemical substance, such as, drugs or alcohol?*
No
Yes

If you answer yes to any of the following, please explain.
Third Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Information
Do you have a history of low blood sugar, diabetes, hemophilia, or other blood related illness?*
No
Yes
Do you have any known allergies to any metals, plastics, or latex?*
No
Yes
Do you have any skin conditions, such as, eczema, psoriasis, or sunburn?*
No
Yes
Do you have a heart condition, epilepsy, or other serious medical condition?*
No
Yes
Are you pregnant or nursing?*
No
Yes
Are you on any medications, such as, blood thinners?*
No
Yes
Are you under the influence of any chemical substance, such as, drugs or alcohol?*
No
Yes

If you answer yes to any of the following, please explain.
Fourth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Information
Do you have a history of low blood sugar, diabetes, hemophilia, or other blood related illness?*
No
Yes
Do you have any known allergies to any metals, plastics, or latex?*
No
Yes
Do you have any skin conditions, such as, eczema, psoriasis, or sunburn?*
No
Yes
Do you have a heart condition, epilepsy, or other serious medical condition?*
No
Yes
Are you pregnant or nursing?*
No
Yes
Are you on any medications, such as, blood thinners?*
No
Yes
Are you under the influence of any chemical substance, such as, drugs or alcohol?*
No
Yes

If you answer yes to any of the following, please explain.
Fifth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Information
Do you have a history of low blood sugar, diabetes, hemophilia, or other blood related illness?*
No
Yes
Do you have any known allergies to any metals, plastics, or latex?*
No
Yes
Do you have any skin conditions, such as, eczema, psoriasis, or sunburn?*
No
Yes
Do you have a heart condition, epilepsy, or other serious medical condition?*
No
Yes
Are you pregnant or nursing?*
No
Yes
Are you on any medications, such as, blood thinners?*
No
Yes
Are you under the influence of any chemical substance, such as, drugs or alcohol?*
No
Yes

If you answer yes to any of the following, please explain.
Sixth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Information
Do you have a history of low blood sugar, diabetes, hemophilia, or other blood related illness?*
No
Yes
Do you have any known allergies to any metals, plastics, or latex?*
No
Yes
Do you have any skin conditions, such as, eczema, psoriasis, or sunburn?*
No
Yes
Do you have a heart condition, epilepsy, or other serious medical condition?*
No
Yes
Are you pregnant or nursing?*
No
Yes
Are you on any medications, such as, blood thinners?*
No
Yes
Are you under the influence of any chemical substance, such as, drugs or alcohol?*
No
Yes

If you answer yes to any of the following, please explain.
Seventh Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Information
Do you have a history of low blood sugar, diabetes, hemophilia, or other blood related illness?*
No
Yes
Do you have any known allergies to any metals, plastics, or latex?*
No
Yes
Do you have any skin conditions, such as, eczema, psoriasis, or sunburn?*
No
Yes
Do you have a heart condition, epilepsy, or other serious medical condition?*
No
Yes
Are you pregnant or nursing?*
No
Yes
Are you on any medications, such as, blood thinners?*
No
Yes
Are you under the influence of any chemical substance, such as, drugs or alcohol?*
No
Yes

If you answer yes to any of the following, please explain.
Eighth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Information
Do you have a history of low blood sugar, diabetes, hemophilia, or other blood related illness?*
No
Yes
Do you have any known allergies to any metals, plastics, or latex?*
No
Yes
Do you have any skin conditions, such as, eczema, psoriasis, or sunburn?*
No
Yes
Do you have a heart condition, epilepsy, or other serious medical condition?*
No
Yes
Are you pregnant or nursing?*
No
Yes
Are you on any medications, such as, blood thinners?*
No
Yes
Are you under the influence of any chemical substance, such as, drugs or alcohol?*
No
Yes

If you answer yes to any of the following, please explain.
Ninth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Information
Do you have a history of low blood sugar, diabetes, hemophilia, or other blood related illness?*
No
Yes
Do you have any known allergies to any metals, plastics, or latex?*
No
Yes
Do you have any skin conditions, such as, eczema, psoriasis, or sunburn?*
No
Yes
Do you have a heart condition, epilepsy, or other serious medical condition?*
No
Yes
Are you pregnant or nursing?*
No
Yes
Are you on any medications, such as, blood thinners?*
No
Yes
Are you under the influence of any chemical substance, such as, drugs or alcohol?*
No
Yes

If you answer yes to any of the following, please explain.
Tenth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Information
Do you have a history of low blood sugar, diabetes, hemophilia, or other blood related illness?*
No
Yes
Do you have any known allergies to any metals, plastics, or latex?*
No
Yes
Do you have any skin conditions, such as, eczema, psoriasis, or sunburn?*
No
Yes
Do you have a heart condition, epilepsy, or other serious medical condition?*
No
Yes
Are you pregnant or nursing?*
No
Yes
Are you on any medications, such as, blood thinners?*
No
Yes
Are you under the influence of any chemical substance, such as, drugs or alcohol?*
No
Yes

If you answer yes to any of the following, please explain.
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address
Email*
Confirm Email*
Check to receive information, news, and discounts by e-mail.
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Last Name*
Phone*
Parent or Guardian's Date of Birth*
Date of Birth
Parent or Guardian's Information
Do you have a history of low blood sugar, diabetes, hemophilia, or other blood related illness?*
No
Yes
Do you have any known allergies to any metals, plastics, or latex?*
No
Yes
Do you have any skin conditions, such as, eczema, psoriasis, or sunburn?*
No
Yes
Do you have a heart condition, epilepsy, or other serious medical condition?*
No
Yes
Are you pregnant or nursing?*
No
Yes
Are you on any medications, such as, blood thinners?*
No
Yes
Are you under the influence of any chemical substance, such as, drugs or alcohol?*
No
Yes

If you answer yes to any of the following, please explain.
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!