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Customer Record Form
Release & Waiver
⚠️ None of this information will be disclosed without your permission. It is for the safety of you and your artist. Please answer honestly. Your information is for our use only and will never be sold or shared with third parties.
Tap YES or NO for each item below. All fields required.
Please take a photo of your government-issued photo ID
(driver's license, passport, or state ID).
📋 HOW TO TAKE YOUR ID PHOTO:
- Tap "Take Photo of ID" below
- Your camera opens automatically
- Hold your ID face-up in front of the lens
- Make sure all four corners are visible
- Tap the white shutter button to snap the photo
- Tap "Use Photo" to confirm — or "Retake" if needed
✓ ID Captured
I HEREBY RELEASE AND FOREVER DISCHARGE DRIPPIN' IN INK, LLC d/b/a FUNHOUSE TATTOOS FORT MYERS, ITS EMPLOYEES, AND ITS AGENTS FROM ANY AND ALL MANNER AND TYPE OF NEGLIGENCE, LIABILITY, CLAIM, ACTION, DEMAND, AND COMPENSATION, IN LAW AND IN EQUITY, WHICH I HAVE OR MIGHT HAVE, NOW OR HEREAFTER, BY REASON OF MY REQUEST TO BE TATTOOED AND/OR PIERCED.
I ALSO SPECIFICALLY RELEASE AND FOREVER DISCHARGE AND RELIEVE DRIPPIN' IN INK, LLC d/b/a FUNHOUSE TATTOOS FORT MYERS, ITS EMPLOYEES, AND ITS AGENTS, FOR ANY AND ALL LOSS OR DAMAGE ON ACCOUNT OF INJURY TO MY PERSON OR PROPERTY CAUSED BY DRIPPIN' IN INK, LLC d/b/a FUNHOUSE TATTOOS FORT MYERS, THEIR EMPLOYEES, OR AGENTS OR NEGLIGENCE OR OTHERWISE, BY REASON OF MY REQUEST TO BE TATTOOED AND OR/PIERCED.
I GIVE PERMISSION TO COPYRIGHT AND/OR PUBLISH ANY PHOTOGRAPH OF MYSELF WITH OR WITHOUT USING MY NAME IN ANY SUCH MANNER AS DEEMED PROPER TO THEIR USE. I REALIZE THAT MISREPRESENTATION, OR FALSIFICATION OF INFORMATION PROVIDED BY ME IS A CRIME, AND IS SUBJECT TO PROSECUTION.
I FURTHER CERTIFY THAT I AM OVER THE AGE OF EIGHTEEN, AND AM NOT INTOXICATED OR UNDER THE INFLUENCE OF ANY NARCOTIC SUBSTANCE, AND MAKE THIS STATEMENT ENTIRELY OF FREE WILL AND SOUND MIND. THIS IS A LEGAL BINDING CONTRACT.
YOU ARE TATTOOED AND PIERCED IN A CLEAN ENVIRONMENT USING STERILE EQUIPMENT AND SUPPLIES AND THE BEST QUALITY PIGMENTS AVAILABLE BY A HIGHLY EXPERIENCED PROFESSIONAL. EVERY CARE IS TAKEN DURING THE APPLICATION OF YOUR TATTOO OR PIERCING. THE HEALING PROCESS DIRECTLY AFFECTS THE END RESULT AND LONGEVITY OF YOUR TATTOO/PIERCING. PLEASE FOLLOW ALL DIRECTIONS OUTLINED UNTIL THE HEALING IS COMPLETE.
AFTERCARE: FUNHOUSE TATTOOS FORT MYERS PROVIDES ALL CLIENTS WITH WRITTEN AFTERCARE INSTRUCTIONS AT THE TIME OF SERVICE. BY SIGNING THIS FORM, I ACKNOWLEDGE THAT I WILL RECEIVE AND AM RESPONSIBLE FOR FOLLOWING ALL AFTERCARE INSTRUCTIONS PROVIDED. I UNDERSTAND THAT PROPER AFTERCARE DIRECTLY AFFECTS THE HEALING, LONGEVITY, AND END RESULT OF MY TATTOO AND/OR PIERCING.
Sign with your finger to confirm you have read and agree to the release above.
Artist — Please Sign Below
Hand the iPad to the artist to confirm service information and sign.
Customer
Sign to confirm you have verified the customer's ID and reviewed their medical disclosure.
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