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SECRET SIDEWALIt TATTOOS <br /> CONSENT FORM <br /> NAME: DATE <br /> DATE OF BIRTH: LICENSE # <br /> ADDRESS: CITY <br /> STATE ZIP CELLPHONE # WORK# <br /> I acknowledge by signing this agreement that I have been given <br /> the full opportunity to ask any questions which I might have about <br /> the obtaining of a tattoo and that all of my questions have been <br /> answered to my satisfaction. <br /> • If I have any condition that might affect the healing of this tattoo, I will <br /> advise my tattoo artist. I am not pregnant or nursing. I am not under the <br /> influence of alcohol or drugs. <br /> • I do not have medical or a skin condition such as but not limited to: acne, <br /> scarring(Keloid) eczema, psoriasis, freckles, moles or sunburn in the area <br /> to be tattooed that may interfere with said tattoo. If I have any type of <br /> infection or rash anywhere on my body, I will advise my artist. <br /> • I acknowledge it is not reasonably possible for the representatives and <br /> employees of this tattoo shop to determine whether I might have an <br /> allergic reaction to the pigments or processes used in my tattoo, and I <br /> agree to accept the risk that such a reaction is possible. <br /> • I've been informed that currently the ink used in my tattoo is not FDA <br /> approved and health consequences are unknown. <br /> • I acknowledge that infection is always possible as a result of the obtaining <br /> of a tattoo, particularly if I do not take proper care of my tattoo. I have <br /> received aftercare instructions and I agree to follow them while my tattoo <br />