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CHURCH, LLC D/B/A WITCHHOUSE TATTOO *** 50 BARTHOLOMEW AVE, HARTFORD CT 06106

WAIVER, RELEASE & CONSENT TO TATTOO

PLEASE INITIAL EACH PROVISION BELOW AFTER READING TO ACKNOWLEDGE THAT YOU UNDERSTAND EACH PROVISION.

In consideration of receiving a tattoo from COURTNEY MOYER (Tattoo Artist at CHURCH LLC D/B/A WITCHHOUSE TATTOO together with its employees, apprentices and agents, (the Tattoo Studio) I agree to the following:

TO WAIVE AND RELEASE to the fullest extent permitted by law each of the Artists and/or Apprentice at 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 the Artists and/or the Apprentice and/or the Tattoo Studio, or otherwise.


That both the Artists and/or the apprentice and/or 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.


The Artists and/or the Apprentice and/or 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 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 being tattooed by the Artists and/or the Apprentice and/or the Tattoo Studio without duress or coercion.


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 condition 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.


Neither the Artists nor the Apprentice 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 any and all other sources.


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 all rights to any photographs taken of me and the tattoo and give consent in advance to their reproduction in print or electronic form.


I agree to reimburse each of the Artists and/or the Apprentice and/or the Tattoo Studio for any attorneys fees and costs incurred in any legal action I bring against either the Artists and/or the Apprentice and/or the Tattoo Studio and in which either the Artist and/or the Apprentice and/or the Tattoo Studio is the prevailing party. I agree that the courts of CONNECTICUT in HARTFORD 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 related to this agreement.


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 Artists and/or the Apprentice and/or the Tattoo Studio.


I hereby declare that I am of legal age (and have provided valid proof of age) and am competent to sign this Agreement. NO ONE UNDER THE LEGAL AGE OF 18 WILL BE ALLOWED TO OBTAIN A TATTOO EVEN IF PARENTAL CONSENT IS AVAILABLE.

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

That I,  have been fully informed of the inherent 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, blood-borne illness, scarring, difficulties in detecting melanoma and allergic reactions to tattoo pigments, 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 I freely accept and expressly assume any and all risks that may arise from tattooing.


Date: March 14, 2025

 

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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.
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 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.


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