8405 Dorsey Circle, Suite 202, Manassas, VA 20110
XIII

waiver, release & consent

Please read every section carefully. You must be 18 years of age or older to be tattooed at The Thirteenth Floor. A valid photo ID is required to confirm your age.

DPOR Licensed Tattoo Shop & Artist Bloodborne Pathogens Certified First Aid & CPR Certified
A fresh waiver is required at every appointment — just like a doctor's office — even if nothing about your health has changed since your last visit.
your info
Please print your full legal name.
Date of birth is required.
Phone number is required.
Please enter a valid email.
Address is required.
Required.
Required.
proof of age
Please upload a photo of your ID.
health & allergies
terms — please read & check each box

In consideration of receiving a tattoo from Francisco Tanchez (the "Artist") and The Thirteenth Floor Tattoo Lounge and its employees, apprentices, and agents, I have been fully informed of the inherent risks associated with getting a tattoo, including but not limited to infection, scarring, difficulty detecting melanoma, and allergic reactions to pigment, latex gloves, and/or soap. Having been informed of these risks, I still wish to proceed and I freely accept and expressly assume any and all risks that may arise from tattooing.

I declare that I am 18 years of age or older, have provided valid proof of age, and am competent to sign this agreement.

I agree to pay the Artist the agreed minimum or the hourly rate. Session time begins at setup and ends at clean-up. Minimum for any tattoo is $400; after the scheduled session time runs out, the additional rate is $400/hr.

I do not have any known allergies to antibiotic ointments, latex, or petroleum products, other than what I've listed above. If I have any, I will tell the Artist before any work begins so equipment and products can be adjusted accordingly.

I waive and release, to the fullest extent permitted by law, the Artist and The Thirteenth Floor from all liability for any claims or causes of action for personal injury or otherwise, including direct and/or consequential damages, arising from the application of my tattoo — whether caused by negligence, fault, or otherwise.

The Artist has given me full opportunity to ask questions about my tattoo, and all my questions have been answered to my satisfaction. The Artist has given me aftercare instructions, which I understand and agree to follow. I understand a tattoo can become infected, particularly from my own negligence, and that any touch-up needed due to my own negligence will be done at my own expense at the hourly rate.

I am not under the influence of alcohol or drugs and am voluntarily submitting to be tattooed without duress or coercion. I do not have diabetes, epilepsy, hemophilia, a heart condition, and do not take blood-thinning medication, unless noted above. I am not pregnant or nursing, and I do not have a mental impairment affecting my judgment in getting this tattoo.

Neither the Artist nor The Thirteenth Floor is responsible for the meaning or spelling of any symbol or text I have provided or chosen. I understand variations may exist between the design I selected and the finished tattoo, and that color and clarity will fade over time due to sun exposure and natural pigment dispersion. Areas of frequent movement (hands, fingers, elbows, joints) will often need touch-ups at my own expense. A tattoo is a permanent change to my appearance, removable only by laser or surgical means, which may be costly, disfiguring, and unlikely to fully restore my original skin.

Photographs: Please ask before photographing the artist. By checking below, I release all rights to any photographs taken of me and my tattoo and consent in advance to their reproduction in print or electronic form (including social media). If you do not wish to consent, leave this box unchecked and tell your artist directly.

I agree to reimburse the Artist and The Thirteenth Floor for attorneys' fees and costs incurred in any legal action I bring against either party in which they are the prevailing party. I agree the courts of Virginia, Fairfax County, have personal jurisdiction and exclusive venue over any dispute arising from this agreement.

I acknowledge I was given adequate opportunity to read and understand this document, that it was not presented to me at the last minute, and that I am signing a legal contract waiving certain rights. I have read this agreement, understand it, and agree to be bound by it in full.

signature
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waiver received.

Thanks — bring your ID with you to your appointment. See you soon.

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